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General NPI Number Information
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NPI Number | 1154364495
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Entity Type | Organization
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Legal Business Name | INDIANAPOLIS BREAST CENTER, PC
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 1950 W 86TH ST SUITE 300
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2076
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Country | US
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Telephone | 317-872-3583
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Fax | 317-872-9856
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Provider Business Mailing Address
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Address Line | 1950 W 86TH ST SUITE 300
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2076
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Country | US
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Telephone | 317-872-3583
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Fax | 317-872-9856
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Authorized Official
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Title or Position | OWNER
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Name | LUCIA M SPEARS
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Credential | MD
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Telephone | 317-872-3583
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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 | 01040614
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License Number State | IN
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