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General NPI Number Information
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NPI Number | 1720375611
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Entity Type | Individual
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Provider Name | AMMAR WAHOOD MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 301 MADISON ST STE 305
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City | JOLIET
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State | IL
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Zip | 60435-6655
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Country | US
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Telephone | 815-729-0450
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Fax |
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Provider Business Mailing Address
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Address Line | 104 CIRCLE RIDGE DR
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City | BURR RIDGE
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State | IL
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Zip | 60527-8379
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Country | US
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Telephone | 630-272-1522
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Fax |
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 036.137498
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036.137498
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License Number State | IL
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