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General NPI Number Information
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NPI Number | 1861622441
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Entity Type | Individual
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Provider Name | PETER ANGELO KEORPES PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 11/04/2017
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Provider Practice Location Address
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Address Line | 374 LARRY POWER RD
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City | BOURBONNAIS
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State | IL
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Zip | 60914-5187
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Country | US
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Telephone | 815-933-2227
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Fax | 815-933-5278
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Provider Business Mailing Address
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Address Line | 820 SPRINGER DR
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City | LOMBARD
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State | IL
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Zip | 60148-6413
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Country | US
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Telephone | 815-933-2227
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Fax | 815-933-5278
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085.004041
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License Number State | IL
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