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General NPI Number Information
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NPI Number | 1477058311
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Entity Type | Individual
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Provider Name | MOHAMMAD SALAH BASHIR MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 15300 WEST AVE STE 220
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City | ORLAND PARK
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State | IL
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Zip | 60462-4508
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Country | US
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Telephone | 708-349-0747
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Fax | 708-349-4551
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Provider Business Mailing Address
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Address Line | 15300 WEST AVE STE 220
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City | ORLAND PARK
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State | IL
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Zip | 60462-4508
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Country | US
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Telephone | 708-349-0747
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Fax | 708-349-4551
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036157757
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License Number State | IL
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