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General NPI Number Information
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NPI Number | 1649321183
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Entity Type | Individual
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Provider Name | VENTRAPRAGADA S MOHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 340 W LINCOLN ST STE 300
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City | BELLEVILLE
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State | IL
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Zip | 62220-1900
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Country | US
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Telephone | 618-235-4883
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Fax | 618-235-9573
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Provider Business Mailing Address
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Address Line | 340 W LINCOLN ST 300
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City | BELLEVILLE
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State | IL
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Zip | 62220-1900
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Country | US
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Telephone | 618-235-4883
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Fax | 618-235-9573
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 36056737
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 36056737
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35338
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 36056737
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License Number State | IL
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