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General NPI Number Information
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NPI Number | 1174701759
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Entity Type | Organization
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Legal Business Name | CHICAGO LASER VEIN INSTITUTE LLC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 2222 W DIVISION ST SUITE 110
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City | CHICAGO
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State | IL
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Zip | 60622-2717
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Country | US
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Telephone | 773-489-3795
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Fax | 773-489-3947
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Provider Business Mailing Address
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Address Line | 777 OAKMONT LN SUITE 1600
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City | WESTMONT
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State | IL
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Zip | 60559-5511
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Country | US
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Telephone | 630-789-2550
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALVARO MONTOYA
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Credential | MD
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Telephone | 312-560-1150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State | IL
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