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General NPI Number Information
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NPI Number | 1427222181
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Entity Type | Organization
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Legal Business Name | FAMINAMED HEALTHCARE PROVIDERS S.C
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 5021 CAROL ST STE 1F
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City | SKOKIE
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State | IL
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Zip | 60077-2202
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Country | US
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Telephone | 312-590-8742
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Fax |
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Provider Business Mailing Address
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Address Line | 5021 CAROL ST STE 1F
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City | SKOKIE
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State | IL
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Zip | 60077-2202
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Country | US
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Telephone | 312-590-8742
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ CEO
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Name | DR. FAROOQ MASOOD AHMED
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Credential | M.D
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Telephone | 312-590-8742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 036.118695
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License Number State | IL
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