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General NPI Number Information
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NPI Number | 1639590540
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Entity Type | Organization
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Legal Business Name | COHEN-LEWE CHICAGO CENTER FOR OSTEOPATHIC MEDICINE
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 111 N WABASH AVE STE. 1818
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City | CHICAGO
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State | IL
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Zip | 60602-1903
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Country | US
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Telephone | 847-830-4866
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Fax |
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Provider Business Mailing Address
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Address Line | 611 DARTMOUTH LN
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City | NEW LENOX
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State | IL
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Zip | 60451-3817
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Country | US
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Telephone | 847-830-4866
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. ADAM COHEN-LEWE
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Credential | D.O.
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Telephone | 847-830-4866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036130877
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License Number State | IL
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