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General NPI Number Information
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NPI Number | 1174667935
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Entity Type | Organization
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Legal Business Name | ROMULO S. ANCOG MD PC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15700 W 10 MILE RD SUITE 107
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2149
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Country | US
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Telephone | 248-646-5288
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Fax |
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Provider Business Mailing Address
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Address Line | 7383 LAHSER RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-4049
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Country | US
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Telephone | 248-646-5288
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROMULO S ANCOG
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Credential | MD
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Telephone | 248-646-5288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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