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General NPI Number Information
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NPI Number | 1346501699
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Entity Type | Individual
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Provider Name | BHARGAV MUDDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 420 S. SCHMIDT ROAD STE. 240
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2634
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Country | US
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Telephone | 630-312-4505
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Fax | 630-312-6651
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Provider Business Mailing Address
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Address Line | 1120 W AVENUE M4
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City | PALMDALE
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State | CA
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Zip | 93551-1432
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Country | US
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Telephone | 661-480-2377
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Fax | 661-480-2378
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036143270
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 036143270
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 036143270
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License Number State | IL
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