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General NPI Number Information
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NPI Number | 1124770334
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Entity Type | Individual
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Provider Name | SAMEH A S A SAIF
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Gender | Male
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 1221 PINE GROVE AVE
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City | PORT HURON
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State | MI
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Zip | 48060-3511
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Country | US
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Telephone | 810-989-3172
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 610458
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City | PORT HURON
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State | MI
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Zip | 48061-0458
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Country | US
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Telephone | 810-357-4098
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301502921
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License Number State | MI
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