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General NPI Number Information
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NPI Number | 1548717697
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Entity Type | Organization
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Legal Business Name | HOPE
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 608 S NOAH TER
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-3556
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Country | US
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Telephone | 847-640-1352
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Fax |
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Provider Business Mailing Address
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Address Line | 608 S NOAH TER
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-3556
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Country | US
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Telephone | 847-640-1352
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ROMA R DSILVA
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Credential | MD
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Telephone | 847-640-1352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0-662-507-3
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License Number State | TX
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