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General NPI Number Information
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NPI Number | 1639155534
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Entity Type | Individual
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Provider Name | ALBERT LEE REYNOLDS MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 901 MC CLINTOCK DRIVE SUITE 202
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City | BURR RIDGE
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State | IL
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Zip | 60527-0844
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Country | US
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Telephone | 888-220-6432
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Fax | 630-654-4253
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Provider Business Mailing Address
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Address Line | PO BOX 746715
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City | ATLANTA
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State | GA
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Zip | 30374-6715
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Country | US
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Telephone | 708-292-7000
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Fax | 708-887-5874
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036065172
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License Number State | IL
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