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General NPI Number Information
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NPI Number | 1477708204
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Entity Type | Organization
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Legal Business Name | CENTER FOR ADULT HEALTHCARE SC
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 303 E ARMY TRAIL RD SUITE 301
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2169
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Country | US
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Telephone | 630-893-0347
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Fax | 630-893-1467
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Provider Business Mailing Address
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Address Line | PO BOX 6365
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-6365
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Country | US
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Telephone | 630-893-0347
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Fax | 630-893-1467
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANDEEP S KOHLI
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Credential | D.O
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Telephone | 630-893-0347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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