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General NPI Number Information
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NPI Number | 1225291842
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Entity Type | Individual
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Provider Name | LUKE MACYSZYN MD, MA
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Gender | Male
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 4551 GLENCOE AVE STE 145
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6385
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Country | US
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Telephone | 424-835-3100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | TORRANCE
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State | CA
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Zip | 90510-3129
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | MT193440
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | A137191
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License Number State | CA
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