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NPI 1306972112

NPI 1306972112 : GEORGE TOMECKI M.D. : BROOKFIELD, IL

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General NPI Number Information
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    NPI Number           |    1306972112
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    Entity Type          |    Individual 
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    Provider Name        |    GEORGE TOMECKI M.D.
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    02/26/2007
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    Last Update Date     |    06/19/2009
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Provider Practice Location Address
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    Address Line         |    8905 BURLINGTON AVE 
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    City                 |    BROOKFIELD
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    State                |    IL
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    Zip                  |    60513
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    Country              |    US
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    Telephone            |    708-387-7000
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    Fax                  |    708-387-7001
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Provider Business Mailing Address
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    Address Line         |    8905 BURLINGTON AVE 
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    City                 |    BROOKFIELD
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    State                |    IL
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    Zip                  |    60513
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    Country              |    US
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    Telephone            |    708-387-7000
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    Fax                  |    708-387-7001
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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        |    207Q00000X
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    Taxonomy Name        |    Family Medicine Physician
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    License Number       |    036-111748
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    License Number State |    IL
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