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General NPI Number Information
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NPI Number | 1598875320
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Entity Type | Individual
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Provider Name | STANLEY JOSEPH KOVAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 1200 S YORK RD #4180
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City | ELMHURST
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State | IL
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Zip | 60126-5626
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Country | US
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Telephone | 630-758-0470
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Fax | 630-758-0471
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Provider Business Mailing Address
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Address Line | 17W535 BUTTERFIELD RD STE 100
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-4010
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Country | US
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Telephone | 708-453-0013
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036072273
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License Number State | IL
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