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General NPI Number Information
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NPI Number | 1235598566
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Entity Type | Organization
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Legal Business Name | MEDPRO VASCULAR INSTITUTE
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 472 BRIARGATE DR UNIT 107
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-2225
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Country | US
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Telephone | 224-535-8758
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Fax |
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Provider Business Mailing Address
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Address Line | 472 BRIARGATE DR UNIT 107
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-2225
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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 | CEO/MEMBER
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Name | MRS. ROBIN HOFFMAN
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Credential |
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Telephone | 224-535-8758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036117153
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License Number State | IL
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