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General NPI Number Information
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NPI Number | 1497930689
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Entity Type | Organization
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Legal Business Name | STROW DERMATOLOGY LTD
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 2041 W ILES AVE
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7005
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Country | US
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Telephone | 217-793-5517
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Fax |
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Provider Business Mailing Address
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Address Line | 2041 W ILES AVE
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7005
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Country | US
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Telephone | 217-793-5517
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Fax |
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Authorized Official
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Title or Position | MD
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Name | M ELIZABETH STROW
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Credential |
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Telephone | 217-793-5517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | IL
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