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General NPI Number Information
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NPI Number | 1750643482
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Entity Type | Individual
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Provider Name | SALIH SAMO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 211 E ONTARIO ST 7TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60611-3468
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Country | US
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Telephone | 847-997-9233
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Fax |
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Provider Business Mailing Address
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Address Line | 338 CUSTER AVE APT 6
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City | EVANSTON
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State | IL
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Zip | 60202-3432
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Country | US
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Telephone | 847-997-9233
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2021029490
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036.133659
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License Number State | IL
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