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General NPI Number Information
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NPI Number | 1063701522
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Entity Type | Organization
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Legal Business Name | WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 720 WESTVIEW DR SW
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City | ATLANTA
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State | GA
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Zip | 30310-1458
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Country | US
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Telephone | 404-616-1424
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Fax |
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Provider Business Mailing Address
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Address Line | 540 E CANFIELD ST
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City | DETROIT
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State | MI
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Zip | 48201-1928
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Country | US
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Telephone | 313-577-5245
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | DR. MARTHA JORDAN
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Credential |
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Telephone | 313-577-2378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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