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General NPI Number Information
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NPI Number | 1548533870
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Entity Type | Organization
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Legal Business Name | SKOKIE MEDICAL CENTER LLC
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 8301 SKOKIE BLVD
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City | SKOKIE
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State | IL
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Zip | 60077-2546
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Country | US
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Telephone | 847-674-4481
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Fax | 847-674-4491
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Provider Business Mailing Address
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Address Line | 3S138 PARK BLVD
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City | GLEN ELLYN
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State | IL
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Zip | 60137-7233
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Country | US
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Telephone | 630-605-2646
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Fax | 630-790-0655
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. MEHDI BASSIRATPOUR
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Credential | M.D.
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Telephone | 630-605-2646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036106820
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License Number State | IL
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