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General NPI Number Information
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NPI Number | 1275815300
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Entity Type | Organization
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Legal Business Name | ST JOSEPH HOSPITAL
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 2756 N PINE GROVE AVE UNIT 308
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City | CHICAGO
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State | IL
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Zip | 60614-6138
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Country | US
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Telephone | 773-857-5107
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Fax |
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Provider Business Mailing Address
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Address Line | 2756 N PINE GROVE AVE UNIT 308
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City | CHICAGO
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State | IL
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Zip | 60614
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Country | US
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Telephone | 773-857-5107
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Fax |
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Authorized Official
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Title or Position | RESIDENT PHYSICIAN
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Name | DINAH LOA
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Credential | MD
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Telephone | 773-318-8702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 125059045
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License Number State | IL
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