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General NPI Number Information
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NPI Number | 1134265994
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Entity Type | Organization
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Legal Business Name | PULMONARY PROVIDERS GROUP, INC.
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 4521 W.LAWRENCE AVE STE.110
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City | CHICAGO
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State | IL
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Zip | 60630-2585
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Country | US
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Telephone | 847-824-0500
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Fax | 847-824-0529
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Provider Business Mailing Address
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Address Line | 4521 W. LAWRENCE AVE. STE.110
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City | CHICAGO
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State | IL
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Zip | 60630-2585
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Country | US
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Telephone | 847-824-0500
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Fax | 847-824-0529
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERZY FISZER
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Credential |
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Telephone | 847-226-3049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 203-
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License Number State | IL
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