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General NPI Number Information
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NPI Number | 1083210488
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Entity Type | Organization
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Legal Business Name | VAX SOLUTION INC
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 19263 E 10 MILE RD STE D
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City | ROSEVILLE
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State | MI
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Zip | 48066-3903
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Country | US
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Telephone | 248-953-0526
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Fax |
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Provider Business Mailing Address
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Address Line | 19263 E 10 MILE RD STE D
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City | ROSEVILLE
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State | MI
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Zip | 48066-3903
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Country | US
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Telephone | 586-238-2060
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MALAZ ALATASSI
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Credential | MD
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Telephone | 248-953-0526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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