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General NPI Number Information
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NPI Number | 1689706111
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Entity Type | Organization
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Legal Business Name | LAKESHORE CANCER CARE,LTD
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Dates
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Enumeration Date | 03/10/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 5020 N ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60640-2880
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Country | US
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Telephone | 773-506-0900
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Fax | 773-506-0909
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Provider Business Mailing Address
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Address Line | 1366 WINNETKA AVE
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City | NORTHFIELD
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State | IL
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Zip | 60093-3539
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Country | US
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Telephone | 847-501-3927
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Fax | 847-501-3927
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NAM E KIM
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Credential | M.D.
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Telephone | 847-501-3927
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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 | 3651679
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License Number State | IL
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