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General NPI Number Information
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NPI Number | 1487975181
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Entity Type | Individual
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Provider Name | LESLIE DALAZA MATTSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 220 SPRINGFIELD DR STE 210
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2215
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Country | US
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Telephone | 630-510-2609
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Fax | 630-539-6049
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Provider Business Mailing Address
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Address Line | PO BOX 713260
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City | CHICAGO
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State | IL
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Zip | 60677-1260
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Country | US
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Telephone | 630-469-9200
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Fax |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036.131651
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036131651
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License Number State | IL
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