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General NPI Number Information
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NPI Number | 1124453527
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Entity Type | Individual
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Provider Name | GREGORY EUGENE ELLCESSOR AU.D.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 3611 S REED RD STE 210
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City | KOKOMO
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State | IN
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Zip | 46902-3828
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Country | US
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Telephone | 765-864-8925
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Fax | 765-864-8926
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone |
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Fax |
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 23002540A
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License Number State | IN
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