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General NPI Number Information
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NPI Number | 1073683439
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Entity Type | Organization
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Legal Business Name | PALOS MEDICAL CARE SC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 12800 S RIDGELAND AVE UNIT D
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463
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Country | US
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Telephone | 708-389-7663
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Fax | 708-389-7664
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Provider Business Mailing Address
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Address Line | PO BOX 762
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City | WORTH
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State | IL
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Zip | 60482
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Country | US
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Telephone | 708-389-7663
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Fax | 708-389-7664
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRANAV PATEL
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Credential | MD
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Telephone | 708-389-7663
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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 | 036091090
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License Number State | IL
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