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General NPI Number Information
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NPI Number | 1730349028
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Entity Type | Individual
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Provider Name | REDOUANE BOUMENDJEL MD
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Gender | Male
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 840 S WOOD ST SUITE 130 CSN
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-996-7250
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 DEMPSTER ST
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City | PARK RIDGE
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State | IL
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Zip | 60068-1143
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Country | US
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Telephone | 847-723-5549
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Fax | 847-723-7540
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 125051840
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License Number State | IL
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