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General NPI Number Information
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NPI Number | 1265539472
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Entity Type | Organization
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Legal Business Name | KEITH M. MONSON, M.D., SC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 N WALL ST SUITE 304
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City | KANKAKEE
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State | IL
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Zip | 60901-2940
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Country | US
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Telephone | 815-932-6400
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Fax | 815-935-7062
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Provider Business Mailing Address
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Address Line | P.O. BOX 1756
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City | KANKAKEE
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State | IL
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Zip | 60901-1756
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Country | US
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Telephone | 815-932-6400
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Fax | 815-935-7062
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH M. MONSON
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Credential | M.D.
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Telephone | 815-932-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | IL
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