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General NPI Number Information
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NPI Number | 1255610440
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Entity Type | Organization
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Legal Business Name | NORTHWEST INDIANA RADIATION ONCOLOGY GROUP, LLC
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 300 W 61ST AVE
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City | HOBART
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State | IN
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Zip | 46342-6490
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Country | US
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Telephone | 219-942-5745
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Fax | 219-462-7902
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Provider Business Mailing Address
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Address Line | PO BOX 660408
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City | INDIANAPOLIS
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State | IN
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Zip | 46266-0408
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Country | US
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Telephone | 219-942-5745
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Fax | 219-462-7902
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KOPPOLU P SARMA
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Credential | MD
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Telephone | 219-942-5745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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