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General NPI Number Information
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NPI Number | 1104083880
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Entity Type | Individual
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Provider Name | MICHAL WOJCIECH WIERCIGROCH DPT
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Gender | Male
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 2835 ORCHARD LAKE RD
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City | KEEGO HARBOR
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State | MI
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Zip | 48320-1448
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Country | US
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Telephone | 248-377-8220
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Fax | 248-341-1219
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Provider Business Mailing Address
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Address Line | PO BOX 412031
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City | BOSTON
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State | MA
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Zip | 02241-2031
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Country | US
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Telephone | 914-294-4050
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Fax | 631-760-8306
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501013770
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License Number State | MI
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