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General NPI Number Information
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NPI Number | 1083785877
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CENTER PC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 25510 PLYMOUTH RD
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City | REDFORD
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State | MI
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Zip | 48239-2025
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Country | US
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Telephone | 313-937-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 25510 PLYMOUTH RD
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City | REDFORD
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State | MI
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Zip | 48239-2025
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Country | US
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Telephone | 313-937-1200
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. THOMAS BONINO SR.
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Credential | MD
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Telephone | 313-937-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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