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General NPI Number Information
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NPI Number | 1194012328
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Entity Type | Individual
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Provider Name | ZACHARY G JAGMIN DPM
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Gender | Male
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | 875 SAINT ANDREWS WAY
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City | FRANKFORT
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State | IL
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Zip | 60423-9705
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Country | US
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Telephone | 708-921-0544
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Fax |
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Provider Business Mailing Address
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Address Line | 875 SAINT ANDREWS WAY
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City | FRANKFORT
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State | IL
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Zip | 60423-9705
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Country | US
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Telephone |
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1055-25
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07001270A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016005625
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License Number State | IL
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