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General NPI Number Information
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NPI Number | 1699864124
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Entity Type | Individual
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Provider Name | IMELDA S CARLOS MD FAAP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 511 THORNHILL DR SUITE F
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City | CAROL STREAM
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State | IL
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Zip | 60188
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Country | US
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Telephone | 630-462-7330
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Fax | 630-462-7385
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Provider Business Mailing Address
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Address Line | 511 THORNHILL DR SUITE F
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City | CAROL STREAM
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State | IL
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Zip | 60188
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Country | US
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Telephone | 630-462-7330
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Fax | 630-462-7385
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036061984
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License Number State | IL
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