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General NPI Number Information
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NPI Number | 1124013578
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Entity Type | Individual
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Provider Name | ABDALI S. JAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 610 N SAWYER RD
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City | KENDALLVILLE
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State | IN
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Zip | 46755-2566
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Country | US
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Telephone | 260-347-5592
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Fax | 260-347-5155
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Provider Business Mailing Address
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Address Line | PO BOX 236
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City | LAGRANGE
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State | IN
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Zip | 46761-0236
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Country | US
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Telephone | 260-463-2133
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Fax | 260-463-3775
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01051996A
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License Number State | IN
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