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General NPI Number Information
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NPI Number | 1548588635
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Entity Type | Individual
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Provider Name | ALIREZA ZADSALAMAT DO
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Gender | Male
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 20201 S. CRAWFORD
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461
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Country | US
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Telephone | 708-747-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 753 JAMES ST APT 827
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City | SYRACUSE
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State | NY
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Zip | 13203-2414
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Country | US
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Telephone |
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A15246
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 20A15246
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License Number State | CA
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