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General NPI Number Information
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NPI Number | 1992032718
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Entity Type | Organization
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Legal Business Name | MIDTOWN MEDICAL CENTER LLC.
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 4527 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60640-5608
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Country | US
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Telephone | 773-275-6300
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Fax | 773-275-6302
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Provider Business Mailing Address
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Address Line | 4527 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60640-5608
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Country | US
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Telephone | 773-275-6300
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Fax | 773-275-6302
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAYANT C BHALERAO
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Credential | M.D
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Telephone | 773-275-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036046837
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License Number State | IL
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