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General NPI Number Information
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NPI Number | 1154433621
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Entity Type | Individual
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Provider Name | JOHN SIFUENTES M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1106 NEAL AVE
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City | JOLIET
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State | IL
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Zip | 60433-2548
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Country | US
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Telephone | 815-727-8670
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Fax |
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Provider Business Mailing Address
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Address Line | 18507 BELLAGIO CIR
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City | TINLEY PARK
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State | IL
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Zip | 60477-4462
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Country | US
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Telephone | 815-685-2183
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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