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General NPI Number Information
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NPI Number | 1811324064
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Entity Type | Organization
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Legal Business Name | METRO PRIMARY CARE ASSOCIATES LLC
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 13755 S. CICERO AVE
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City | CRESTWOOD
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State | IL
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Zip | 60445-1824
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Country | US
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Telephone | 708-972-7642
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Fax | 708-925-9179
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Provider Business Mailing Address
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Address Line | 901 MCCLINTOCK DRIVE SUITE 202
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City | BURR RIDGE
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State | IL
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Zip | 60527-0844
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Country | US
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Telephone | 888-220-6432
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Fax | 630-654-4253
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | ASHLEY ROCK
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Credential |
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Telephone | 708-972-7636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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