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General NPI Number Information
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NPI Number | 1922169440
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Entity Type | Individual
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Provider Name | MOHAMMAD A GAFOOR M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 675 W NORTH AVE STE. 408
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City | MELROSE PARK
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State | IL
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Zip | 60160-1634
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Country | US
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Telephone | 708-450-4950
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Fax | 708-343-8508
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Provider Business Mailing Address
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Address Line | 675 W NORTH AVE STE. 408
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City | MELROSE PARK
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State | IL
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Zip | 60160-1634
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Country | US
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Telephone | 708-450-4950
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Fax | 708-343-8508
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036059677
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License Number State | IL
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