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General NPI Number Information
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NPI Number | 1538615836
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF ILLINOIS HOSPITAL
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 08/28/2016
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Provider Practice Location Address
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Address Line | 1463 W WINNEMAC AVE UNIT 2E
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City | CHICAGO
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State | IL
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Zip | 60640
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Country | US
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Telephone | 586-201-0815
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Fax |
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Provider Business Mailing Address
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Address Line | 1463 W WINNEMAC AVE UNIT 2E
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City | CHICAGO
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State | IL
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Zip | 60640-2800
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Country | US
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Telephone | 586-201-0815
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Fax |
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Authorized Official
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Title or Position | MD
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Name | JAMES BUI
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Credential |
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Telephone | 312-996-0241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 281P00000X
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Taxonomy Name | Chronic Disease Hospital
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License Number | 209014067
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License Number State | IL
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