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General NPI Number Information
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NPI Number | 1649703901
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Entity Type | Individual
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Provider Name | MENG GAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 2520 ELISHA AVENUE
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City | ZION
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State | IL
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Zip | 60099
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Country | US
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Telephone | 800-322-9183
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Fax | 319-272-2807
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Provider Business Mailing Address
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Address Line | 2361 PAYSPHERE CIRCLE
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City | CHICAGO
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State | IL
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Zip | 60067
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Country | US
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Telephone | 800-322-9183
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Fax | 319-272-2807
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD-50129
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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