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General NPI Number Information
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NPI Number | 1649578238
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Entity Type | Organization
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Legal Business Name | REYNALDO M. CALUAG MD SC
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 03/25/2011
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Provider Practice Location Address
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Address Line | 1111 SUPERIOR ST SUITE 411
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City | MELROSE PARK
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State | IL
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Zip | 60160-4138
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Country | US
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Telephone | 708-345-2140
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Fax | 708-345-2141
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Provider Business Mailing Address
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Address Line | 1111 SUPERIOR ST SUITE 411
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City | MELROSE PARK
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State | IL
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Zip | 60160-4138
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Country | US
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Telephone | 708-345-2140
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Fax | 708-345-2141
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REYNALDO MARTIN CALUAG
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Credential | MD
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Telephone | 708-345-2140
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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 | 036096640
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License Number State | IL
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