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General NPI Number Information
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NPI Number | 1073856704
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Entity Type | Organization
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Legal Business Name | CENTER FOR INTERGRATED NEUROLOGY PLC
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 43000 W 9 MILE RD STE 110
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City | NOVI
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State | MI
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Zip | 48375-4180
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Country | US
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Telephone | 248-277-3334
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Fax | 248-277-3337
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Provider Business Mailing Address
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Address Line | 43000 W 9 MILE RD STE 110
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City | NOVI
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State | MI
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Zip | 48375-4180
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Country | US
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Telephone | 248-277-3334
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Fax | 248-277-3337
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOHN D RUSSELL
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Credential |
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Telephone | 313-228-0930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4301079196
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License Number State | MI
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