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General NPI Number Information
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NPI Number | 1245737253
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Entity Type | Individual
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Provider Name | SAMRIDHI GULATI MD
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Gender | Female
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Dates
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Enumeration Date | 04/07/2018
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1340 CHARLES ST STE 401
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City | ROCKFORD
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State | IL
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Zip | 61104-2200
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Country | US
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Telephone | 779-696-6102
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 E ROOSEVELT ST
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City | PHOENIX
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State | AZ
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Zip | 85008-4973
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Country | US
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Telephone | 602-344-5011
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036.167746
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036167746
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License Number State | IL
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