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General NPI Number Information
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NPI Number | 1932136389
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER AT 900 N MICHIGAN AVE LLC
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 60 E DELAWARE PL 15TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60611-1898
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Country | US
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Telephone | 312-440-5150
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Fax | 877-235-5009
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Provider Business Mailing Address
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Address Line | PO BOX 88185
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City | CAROL STREAM
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State | IL
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Zip | 60188-8185
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Country | US
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Telephone | 312-440-5150
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Fax | 312-858-6104
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Authorized Official
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Title or Position | CEO
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Name | DR. KENNY BOZORGI
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Credential | MD
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Telephone | 312-440-5150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | IL
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