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General NPI Number Information
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NPI Number | 1669604625
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Entity Type | Individual
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Provider Name | JOSE G DUARTE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 197 N LARCH AVE
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City | ELMHURST
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State | IL
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Zip | 60126-2724
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Country | US
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Telephone | 630-667-7726
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Fax | 630-530-4717
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Provider Business Mailing Address
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Address Line | 197 N LARCH AVE
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City | ELMHURST
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State | IL
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Zip | 60126-2724
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Country | US
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Telephone | 630-667-7726
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Fax | 630-530-4717
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036-052007
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License Number State | IL
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