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General NPI Number Information
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NPI Number | 1215191630
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Entity Type | Organization
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Legal Business Name | MANZOOR HUSSAIN SHAH M.D.S.C
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 1479 RING RD
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City | CALUMET CITY
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State | IL
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Zip | 60409-5459
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Country | US
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Telephone | 708-891-2181
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Fax |
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Provider Business Mailing Address
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Address Line | 1479 RING RD
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City | CALUMET CITY
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State | IL
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Zip | 60409-5459
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Country | US
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Telephone | 708-891-2181
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANZOOR HUSSAIN SHAH
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Credential | M.D
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Telephone | 708-921-1697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036049259
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License Number State | IL
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