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Individual
OMOD HALLY
Active
Individual
OMOD HALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
041.401278
IL
Other
Enumeration date
10/05/2026
Last updated
10/05/2026
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