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General NPI Number Information
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NPI Number | 1588947626
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Entity Type | Organization
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Legal Business Name | RESSURECTION
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 2900 N LAKE SHORE DR DEPT. OF MEDICINE
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City | CHICAGO
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State | IL
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Zip | 60657-5640
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Country | US
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Telephone | 773-665-3022
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 N LAKE SHORE DR DEPT. OF MEDICINE
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City | CHICAGO
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State | IL
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Zip | 60657-5640
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Country | US
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Telephone | 773-665-3022
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Fax |
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Authorized Official
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Title or Position | CO ORDINATOR
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Name | MR. HAROLD HAYES
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Credential |
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Telephone | 773-665-3022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 125058493
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License Number State | IL
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