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General NPI Number Information
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NPI Number | 1518158138
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Entity Type | Organization
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Legal Business Name | MD CARE CENTER SC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 2740 W. FOSTER SUITE 205
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City | CHICAGO
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State | IL
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Zip | 60625
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Country | US
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Telephone | 773-878-6550
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Fax | 773-878-6557
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Provider Business Mailing Address
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Address Line | 6533 N. TRUMBULL AVENUE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-3834
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Country | US
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Telephone | 773-878-6550
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Fax | 773-878-6557
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Authorized Official
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Title or Position | MD
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Name | MILENKO LAZAREVIC
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Credential | MD
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Telephone | 773-878-6550
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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 | 036095635
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License Number State | IL
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