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General NPI Number Information
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NPI Number | 1225289069
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Entity Type | Organization
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Legal Business Name | COVENANT FAMILY CARE PLLC
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 33155 ANNAPOLIS ST
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City | WAYNE
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State | MI
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Zip | 48184-2405
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Country | US
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Telephone | 734-593-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 7432 RAFFORD LN
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3194
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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 | OWNER
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Name | SARAH S. JACOB
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Credential | MD
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Telephone | 248-890-3603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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