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General NPI Number Information
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NPI Number | 1013014158
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Entity Type | Organization
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Legal Business Name | HEALTHPARTNERS MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 1225 E COOLSPRING AVE
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-6312
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Country | US
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Telephone | 219-879-6531
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Fax | 219-878-5015
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Provider Business Mailing Address
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Address Line | 35682 EAGLE WAY
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City | CHICAGO
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State | IL
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Zip | 60678-1356
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Country | US
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Telephone | 219-879-6531
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Fax | 219-872-7869
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Authorized Official
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Title or Position | DIRECTOR
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Name | AMY KELLER
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Credential |
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Telephone | 219-873-2905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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