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General NPI Number Information
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NPI Number | 1962583427
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Entity Type | Individual
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Provider Name | JOHN MICHAEL CRULCICH A.P.N., F.N.P.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 333 S STATE ST ROOM 2143
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City | CHICAGO
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State | IL
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Zip | 60604-3900
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Country | US
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Telephone | 312-747-9678
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Fax | 312-747-9420
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Provider Business Mailing Address
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Address Line | 734 S MILLER ST
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City | CHICAGO
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State | IL
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Zip | 60607-3409
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Country | US
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Telephone | 312-421-3392
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209-002450(41-19641)
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License Number State | IL
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