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General NPI Number Information
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NPI Number | 1134416977
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Entity Type | Individual
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Provider Name | SUSHRUTA SHANTANU NAGARKATTI M.B.B.S.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 611 E DOUGLAS RD STE 207
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City | MISHAWAKA
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State | IN
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Zip | 46545-1465
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Country | US
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Telephone | 574-335-6850
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Fax | 574-335-0849
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Provider Business Mailing Address
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Address Line | 5215 HOLY CROSS PKWY
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City | MISHAWAKA
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State | IN
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Zip | 46545-1469
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Country | US
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Telephone | 574-335-8707
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 4301503008
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 01094815A
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License Number State | IN
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