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General NPI Number Information
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NPI Number | 1942356357
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Entity Type | Individual
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Provider Name | RAJAGOPAL K REDDY M.D. FA.C.C.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1431 N WESTERN AVE SUITE 503
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City | CHICAGO
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State | IL
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Zip | 60622-1797
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Country | US
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Telephone | 773-489-7979
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Fax | 773-489-7908
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Provider Business Mailing Address
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Address Line | 1431 N WESTERN AVE SUITE 503
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City | CHICAGO
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State | IL
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Zip | 60622-1797
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Country | US
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Telephone | 773-489-7979
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Fax | 773-489-7908
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036-055690
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License Number State | IL
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