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General NPI Number Information
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NPI Number | 1538200308
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Entity Type | Individual
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Provider Name | OMEED MEMAR MD
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 50 E WASHINGTON ST STE 200
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City | CHICAGO
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State | IL
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Zip | 60602-2154
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Country | US
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Telephone | 312-230-0180
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Fax | 312-230-0181
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Provider Business Mailing Address
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Address Line | PO BOX 809397
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City | CHICAGO
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State | IL
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Zip | 60680-9397
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Country | US
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Telephone | 312-230-0180
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Fax | 312-230-0181
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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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 336061711
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License Number State | IL
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