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General NPI Number Information
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NPI Number | 1033393889
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Entity Type | Organization
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Legal Business Name | UMESH P. GOSWAMI, MD SC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 625 BETHANY RD SUITE 3
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City | DEKALB
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State | IL
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Zip | 60115-4908
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Country | US
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Telephone | 815-758-5100
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Fax | 815-758-5144
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Provider Business Mailing Address
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Address Line | 625 BETHANY RD SUITE 3
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City | DEKALB
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State | IL
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Zip | 60115-4908
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Country | US
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Telephone | 815-758-5100
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Fax | 815-758-5144
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Authorized Official
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Title or Position | OWNER
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Name | DR. UMESH P GOSWAMI
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Credential | MD
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Telephone | 815-758-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 042005119
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License Number State | IL
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