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General NPI Number Information
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NPI Number | 1811309016
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Entity Type | Individual
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Provider Name | ROBERT MOUSSELLI
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Gender | Male
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 2200 PARK BEND DR STE 300
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City | AUSTIN
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State | TX
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Zip | 78758-5386
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Country | US
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Telephone | 512-994-4159
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Fax |
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Provider Business Mailing Address
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Address Line | 180 HARVESTER DR STE 110
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City | BURR RIDGE
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State | IL
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Zip | 60527-6686
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Country | US
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Telephone | 773-702-1150
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036.163144
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | V0067
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License Number State | TX
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