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General NPI Number Information
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NPI Number | 1619019304
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Entity Type | Individual
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Provider Name | MICHAEL MAITAR MD
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 304 W HAY ST STE 313
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City | DECATUR
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State | IL
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Zip | 62526-4170
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Country | US
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Telephone | 217-876-2756
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Fax | 217-876-3585
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Provider Business Mailing Address
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Address Line | 304 W HAY ST STE 313
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City | DECATUR
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State | IL
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Zip | 62526-4170
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Country | US
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Telephone | 217-876-2756
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Fax | 217-876-3585
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 64928-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036081217
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License Number State | IL
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