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General NPI Number Information
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NPI Number | 1942628383
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Entity Type | Organization
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Legal Business Name | PEAKLIFEMD, S.C.
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 1603 ORRINGTON AVE SUITE 600
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City | EVANSTON
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State | IL
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Zip | 60201-3841
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Country | US
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Telephone | 847-946-0855
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Fax |
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Provider Business Mailing Address
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Address Line | 303 W OHIO ST UNIT 2007
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City | CHICAGO
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State | IL
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Zip | 60654-7963
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Country | US
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Telephone | 847-946-0855
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | UTPAL DHRUVE
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Credential | M.D.
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Telephone | 847-946-0855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036128875
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License Number State | IL
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