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General NPI Number Information
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NPI Number | 1609316686
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Entity Type | Organization
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Legal Business Name | KV FOOT AND ANKLE PC
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 629 COLUMBINE AVE
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City | LISLE
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State | IL
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Zip | 60532-2711
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Country | US
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Telephone | 708-341-6428
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Fax |
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Provider Business Mailing Address
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Address Line | 629 COLUMBINE AVE
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City | LISLE
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State | IL
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Zip | 60532-2711
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Country | US
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Telephone | 708-341-6428
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SARAH ANN SUMMER MATOUK
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Credential | DPM
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Telephone | 708-341-6428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005612
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016005612
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License Number State | IL
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