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General NPI Number Information
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NPI Number | 1043713324
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Entity Type | Organization
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Legal Business Name | JAVIER MORENO MD CORP
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 1819 N NORMANDY AVE
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City | CHICAGO
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State | IL
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Zip | 60707-3927
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Country | US
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Telephone | 847-620-9116
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Fax | 844-718-2707
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Provider Business Mailing Address
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Address Line | 1819 N NORMANDY AVE
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City | CHICAGO
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State | IL
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Zip | 60707-3927
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Country | US
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Telephone | 847-620-9116
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Fax | 844-718-2707
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAVIER A MORENO
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Credential | MD
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Telephone | 847-620-9116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-052532
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License Number State | IL
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