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General NPI Number Information
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NPI Number | 1679744643
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Entity Type | Organization
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Legal Business Name | SUMMIT MEDICAL CENTER S.C.
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 6252 S ARCHER RD
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City | SUMMIT
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State | IL
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Zip | 60501-1720
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Country | US
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Telephone | 708-496-9549
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Fax | 708-728-9429
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Provider Business Mailing Address
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Address Line | 6252 S ARCHER RD
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City | SUMMIT
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State | IL
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Zip | 60501-1720
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Country | US
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Telephone | 708-496-9549
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Fax | 708-728-9429
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANKIT SHAH
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Credential | MD
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Telephone | 708-496-9549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036086195
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License Number State | IL
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