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General NPI Number Information
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NPI Number | 1487889903
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Entity Type | Individual
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Provider Name | MARK D CECILIO MD
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Gender | Male
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 1414 W FAIR AVE STE 36
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City | MARQUETTE
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State | MI
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Zip | 49855-2675
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Country | US
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Telephone | 906-225-3864
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Fax | 906-225-3851
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Provider Business Mailing Address
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Address Line | 4602 DEPT
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City | CAROL STREAM
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State | IL
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Zip | 60122-0021
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Country | US
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Telephone | 906-225-4606
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Fax | 906-225-4537
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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