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General NPI Number Information
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NPI Number | 1396981460
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Entity Type | Organization
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Legal Business Name | INDIANA REGIONAL SLEEP DISORDER CENTER, INC
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Dates
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Enumeration Date | 12/19/2008
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 2850 S WABASH AVE
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City | CHICAGO
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State | IL
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Zip | 60616-2955
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Country | US
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Telephone | 219-944-4187
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Fax | 219-944-4196
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Provider Business Mailing Address
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Address Line | 55 E 86TH AVE PO BOX 10645
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6382
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Country | US
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Telephone | 219-769-1670
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Fax | 219-738-6714
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | OLUSEGUN APATA
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Credential | MD
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Telephone | 219-944-4187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036-119770
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036119770
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 036-119770
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License Number State | IL
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