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General NPI Number Information
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NPI Number | 1659603868
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Entity Type | Organization
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Legal Business Name | PINAKINPRASAD DAVE, MD, SC
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 1851 SIBLEY BLVD
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City | CALUMET CITY
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State | IL
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Zip | 60409-2252
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Country | US
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Telephone | 708-868-2300
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Fax | 708-868-2304
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Provider Business Mailing Address
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Address Line | 1940 E 170TH PL
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-3703
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Country | US
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Telephone | 708-895-6439
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PINAKINPRASAD DAVE
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Credential | M.D.
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Telephone | 708-895-6439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036055316
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License Number State | IL
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