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General NPI Number Information
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NPI Number | 1588041099
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Entity Type | Individual
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Provider Name | SARAH JO WILSON MD
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Gender | Female
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 676 N SAINT CLAIR ST STE 1600
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City | CHICAGO
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State | IL
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Zip | 60611-2997
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Country | US
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Telephone | 404-513-6372
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 W WRIGHTWOOD AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60614-1315
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Country | US
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Telephone | 404-513-6372
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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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 036.148813
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License Number State | IL
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