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General NPI Number Information
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NPI Number | 1164468021
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Entity Type | Individual
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Provider Name | OLEZIA COMSULEA M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 2929 S ELLIS AVE
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City | CHICAGO
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State | IL
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Zip | 60616-3395
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Country | US
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Telephone | 708-791-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 8263 HESS AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-5219
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Country | US
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Telephone | 708-246-2381
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | IL
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