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General NPI Number Information
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NPI Number | 1912218009
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Entity Type | Individual
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Provider Name | IKENNA CHIKEZIRI OKPAREKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 301 MADISON ST SUITE 305
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City | JOLIET
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State | IL
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Zip | 60435-6549
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Country | US
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Telephone | 815-729-0450
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Fax | 815-729-0459
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Provider Business Mailing Address
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Address Line | 19627 LA GRANGE RD
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City | MOKENA
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State | IL
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Zip | 60448-9360
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Country | US
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Telephone | 815-729-0450
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Fax | 815-729-0459
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 125.054301
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 036-127377
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License Number State | IL
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