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General NPI Number Information
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NPI Number | 1962202762
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Entity Type | Organization
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Legal Business Name | RESTORATIVE ASSURANCE
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 14724 S LA GRANGE RD STE 17
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City | ORLAND PARK
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State | IL
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Zip | 60462-3227
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Country | US
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Telephone | 773-329-9237
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Fax |
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Provider Business Mailing Address
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Address Line | 649 E GLENWOOD LANSING RD APT 1B
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City | GLENWOOD
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State | IL
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Zip | 60425-1939
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Country | US
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Telephone | 773-329-9237
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Fax |
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Authorized Official
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Title or Position | CRANIAL PROSTHETIC SPECIALIST
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Name | MS. JOSALYN MILES
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Credential |
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Telephone | 773-329-9237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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