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General NPI Number Information
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NPI Number | 1639327828
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Entity Type | Organization
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Legal Business Name | MULFORD MEDICAL LLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 657 S MULFORD RD
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City | ROCKFORD
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State | IL
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Zip | 61108-2533
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Country | US
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Telephone | 815-229-9900
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Fax | 815-229-9953
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Provider Business Mailing Address
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Address Line | 657 S MULFORD RD
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City | ROCKFORD
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State | IL
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Zip | 61108-2533
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Country | US
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Telephone | 815-229-9900
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Fax | 815-229-9953
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Authorized Official
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Title or Position | MEMBER
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Name | DR. THEODORE H. SCHOCK
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Credential | D.O.
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Telephone | 815-229-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036096167
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License Number State | IL
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