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General NPI Number Information
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NPI Number | 1861385437
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Entity Type | Individual
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Provider Name | LUIS ORLANDO TORRES-GONZALEZ MD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 530 NE GLEN OAK AVE
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City | PEORIA
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State | IL
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Zip | 61637-0001
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Country | US
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Telephone | 309-655-7768
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 W LAKE SHORE DR
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City | EDELSTEIN
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State | IL
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Zip | 61526-9503
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Country | US
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Telephone | 414-477-1283
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 125.086140
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License Number State | IL
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