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General NPI Number Information
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NPI Number | 1396061859
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Entity Type | Individual
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Provider Name | JUAN L VEGA MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | W3985 COUNTY ROAD NN
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City | ELKHORN
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State | WI
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Zip | 53121-4337
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Country | US
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Telephone | 262-741-2000
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Fax | 262-741-2180
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 262-741-2000
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Fax | 262-741-2180
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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 | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 57028
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 57028
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License Number State | WI
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