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General NPI Number Information
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NPI Number | 1629123716
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Entity Type | Individual
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Provider Name | AMY R DYSART MD
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 1 INGALLS DR
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City | HARVEY
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State | IL
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Zip | 60426-3558
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Country | US
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Telephone | 855-826-3878
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Fax |
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Provider Business Mailing Address
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Address Line | 150 HARVESTER DR STE 300
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City | BURR RIDGE
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State | IL
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Zip | 60527-5965
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Country | US
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Telephone |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 43777
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036-165653
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License Number State | IL
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