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General NPI Number Information
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NPI Number | 1457356958
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Entity Type | Individual
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Provider Name | TRACI E. POWELL MD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9415 S WESTERN AVE STE 201A
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City | CHICAGO
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State | IL
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Zip | 60620-6230
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Country | US
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Telephone | 773-779-9700
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Fax | 773-779-9732
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Provider Business Mailing Address
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Address Line | 2944 W 86TH PL
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City | CHICAGO
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State | IL
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Zip | 60652-3830
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Country | US
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Telephone | 773-471-7795
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Fax | 773-471-7796
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | IL
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