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General NPI Number Information
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NPI Number | 1326436767
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Entity Type | Organization
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Legal Business Name | MICHAEL VOSICKY DO FAMILY HEALTHCARE LLC
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 245 S GARY AVE SUITE 204
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2228
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Country | US
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Telephone | 630-351-9170
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Fax |
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Provider Business Mailing Address
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Address Line | 245 S GARY AVE SUITE 204
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2228
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Country | US
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Telephone | 630-351-9170
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL VOSICKY
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Credential | DO
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Telephone | 630-351-9170
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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 | 036082782
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License Number State | IL
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