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General NPI Number Information
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NPI Number | 1073243911
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Entity Type | Organization
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Legal Business Name | HALCYON MEDICAL GROUP LLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 6241 MAIN ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-1909
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Country | US
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Telephone | 312-394-0571
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 561
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City | OREGON
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State | IL
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Zip | 61061-0561
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Country | US
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Telephone | 312-394-0571
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMAAD BASITH
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Credential | MD
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Telephone | 312-394-0571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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