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General NPI Number Information
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NPI Number | 1215045877
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PAIN CARE SC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 71 W 156TH ST SUITE 205
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City | HARVEY
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State | IL
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Zip | 60426-4260
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Country | US
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Telephone | 708-596-3344
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Fax | 708-596-3432
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Provider Business Mailing Address
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Address Line | PO BOX 5986
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City | CAROL STREAM
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State | IL
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Zip | 60197-5986
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Country | US
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Telephone | 847-677-6410
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Fax | 847-677-6420
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOLLY S CAROBENE
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Credential | M.D.
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Telephone | 815-363-8617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 036074517
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License Number State | IL
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