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General NPI Number Information
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NPI Number | 1588960132
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Entity Type | Organization
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Legal Business Name | ALMANSUR FAMILY PRACTICE SERVICES LTD
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 04/02/2011
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Provider Practice Location Address
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Address Line | 7318 MADISON ST
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City | FOREST PARK
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State | IL
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Zip | 60130-3100
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Country | US
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Telephone | 708-366-1871
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Fax |
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Provider Business Mailing Address
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Address Line | 209 MIDDAUGH RD
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City | CLARENDON HILLS
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State | IL
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Zip | 60514-1003
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Country | US
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Telephone | 630-974-7084
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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. BAHIR MANSUR
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Credential | M.D.
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Telephone | 708-366-1871
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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 | 036065718
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License Number State | IL
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