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General NPI Number Information
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NPI Number | 1215783766
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Entity Type | Organization
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Legal Business Name | REDREEF ANESTHESIA ASSOCIATES CHARTERED INDIANA LLC
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 600 GRANT ST
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City | GARY
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State | IN
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Zip | 46402-6001
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Country | US
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Telephone | 888-851-4642
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 88848
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City | CAROL STREAM
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State | IL
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Zip | 60188-0848
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Country | US
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Telephone | 888-851-4642
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. RONALD HAYES
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Credential | MD
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Telephone | 815-651-9729
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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 |
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