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General NPI Number Information
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NPI Number | 1790233609
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Entity Type | Organization
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Legal Business Name | RONNIE MANDAL DO, SC
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 2740 W FOSTER AVE STE 101
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City | CHICAGO
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State | IL
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Zip | 60625-3547
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Country | US
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Telephone | 773-545-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 6634 N TRUMBULL AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-3738
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Country | US
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Telephone | 847-757-5880
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONNIE RANJAN MANDAL
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Credential | DO
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Telephone | 847-757-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 036119779
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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