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General NPI Number Information
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NPI Number | 1003405762
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Entity Type | Organization
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Legal Business Name | INDIANA ALLERGY AND ASTHMA LLC
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 9012 CONNECTICUT ST
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7057
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Country | US
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Telephone | 219-769-6177
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Fax |
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Provider Business Mailing Address
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Address Line | 9012 CONNECTICUT ST
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7057
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Country | US
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Telephone | 219-769-6177
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. POOJA OZA PATEL
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Credential | MD
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Telephone | 847-361-3602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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