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General NPI Number Information
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NPI Number | 1134190721
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Entity Type | Individual
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Provider Name | CLIVE LIONEL ALONZO M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 600 GRANT ST
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City | GARY
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State | IN
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Zip | 46402-6001
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Country | US
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Telephone | 773-368-6395
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Fax |
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Provider Business Mailing Address
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Address Line | 11831 S BISHOP ST
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City | CHICAGO
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State | IL
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Zip | 60643-5013
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Country | US
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Telephone | 773-368-6395
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036112177
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01060964A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036112177
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License Number State | IL
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