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General NPI Number Information
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NPI Number | 1942693650
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Entity Type | Individual
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Provider Name | ANNIKA NAROTAM D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 5145 N CALIFORNIA AVE ATTN: GME OFFICE
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City | CHICAGO
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State | IL
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Zip | 60625-3661
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Country | US
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Telephone | 773-989-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 2461 OAKCREST LN
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City | TERRE HAUTE
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State | IN
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Zip | 47803-9695
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 68611
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License Number State | WI
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