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General NPI Number Information
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NPI Number | 1972717510
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Entity Type | Individual
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Provider Name | MACLONG TONY TRAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7435 W TALCOTT AVE RESURRECTION MEDICAL CENTER, EMERGENCY DEPARTMENT
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City | CHICAGO
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State | IL
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Zip | 60631-3707
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Country | US
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Telephone | 773-594-7871
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Fax |
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Provider Business Mailing Address
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Address Line | 1391 WEST BLVD
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City | BERKLEY
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State | MI
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Zip | 48072-2082
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Country | US
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Telephone | 713-927-7988
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036.118216
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License Number State | IL
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