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General NPI Number Information
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NPI Number | 1003955485
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Entity Type | Organization
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Legal Business Name | MICHIANA HEMATOLOGY-ONCOLOGY P C
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 5340 HOLY CROSS PKWY
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City | MISHAWAKA
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State | IN
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Zip | 46545-1470
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Country | US
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Telephone | 574-237-1328
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Fax | 574-968-8488
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Provider Business Mailing Address
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Address Line | PO BOX 746092
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City | ATLANTA
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State | GA
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Zip | 30374-6092
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Country | US
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Telephone | 574-237-1328
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Fax | 574-237-1348
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Authorized Official
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Title or Position | PRESIDENT
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Name | BILAL ANSARI
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Credential | MD
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Telephone | 574-261-0794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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