Basic Information
| Provider Information | |||||||||
| NPI: | 1679835128 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | QIN | ||||||||
| FirstName: | CURTIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 W HARRISON ST STE 466 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129425495 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 E ROOSEVELT ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850084973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023445011 | ||||||||
| FaxNumber: | 6023445596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 09/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0204X | 58591 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.