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General NPI Number Information
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NPI Number | 1518984228
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Entity Type | Organization
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Legal Business Name | DEKALB CLINIC CHARTERED
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 165 E PLANK RD
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City | SYCAMORE
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State | IL
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Zip | 60178-8757
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Country | US
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Telephone | 815-758-8671
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Fax | 815-758-1731
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Provider Business Mailing Address
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Address Line | 217 FRANKLIN ST
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City | DEKALB
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State | IL
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Zip | 60115-3742
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Country | US
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Telephone | 815-758-8671
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Fax | 815-758-1731
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Authorized Official
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Title or Position | CHAIRMAN, BOARD OF DIRECTORS
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Name | WILLIAM K LEE
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Credential | M.D.
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Telephone | 815-758-8671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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