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General NPI Number Information
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NPI Number | 1093383564
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Entity Type | Individual
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Provider Name | YANNICK MAXIME MOMO TEFO DPT, DPM
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Gender | Male
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 5515 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509-2603
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Country | US
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Telephone | 814-868-8217
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 WILLIAMSBURG CIR
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City | GRAYSLAKE
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State | IL
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Zip | 60030-7904
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Country | US
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Telephone | 563-676-3316
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.024167
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC007589
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License Number State | PA
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