Provider Demographics
NPI:1568428217
Name:QIN, XIUSHENG (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:XIUSHENG
Middle Name:
Last Name:QIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DR STE 1370
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4300
Mailing Address - Country:US
Mailing Address - Phone:317-837-5566
Mailing Address - Fax:
Practice Address - Street 1:8244 E US HIGHWAY 36 STE 1340
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9688
Practice Address - Country:US
Practice Address - Phone:317-520-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090372207R00000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.090372OtherSTATE LICENSE
OH2964529Medicaid
OH35.090372OtherSTATE LICENSE
BQ9705332OtherDEA
OH000001158549OtherANTHEM
MII52639OtherTRICARE
MI4868804Medicaid
MI38507OtherHEALTH PLAN OF MICHIGAN MEDICAID HMO
MI0N89040Medicare PIN
MI830007320OtherRAIL ROAD MEDICARE
MIXQ087497OtherBLUE CROSS BLUE SHIELD MICHIGAN
MII52639Medicare UPIN