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General NPI Number Information
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NPI Number | 1295211373
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Entity Type | Individual
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Provider Name | ABDUL MOIZ KHAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 3535 N BELL SCHOOL RD
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City | ROCKFORD
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State | IL
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Zip | 61114-6624
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Country | US
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Telephone | 779-696-9400
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Fax | 779-696-9365
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Provider Business Mailing Address
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Address Line | 47 NEW SCOTLAND AVE DEPT OF INTERNAL MEDICINE
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City | ALBANY
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State | NY
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Zip | 12208-3412
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Country | US
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Telephone | 518-262-3095
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 64034
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 036167261
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License Number State | IL
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