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General NPI Number Information
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NPI Number | 1265939656
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Entity Type | Organization
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Legal Business Name | INDIANA HERNIA CENTER, LLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 8435 CLEARVISTA PL STE 104
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3761
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Country | US
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Telephone | 317-868-1305
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Fax | 317-645-1477
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Provider Business Mailing Address
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Address Line | 2937 GADSEN CIR S
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City | CARMEL
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State | IN
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Zip | 46032-8393
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Country | US
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Telephone | 317-868-1305
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Fax | 317-645-1477
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL SZOTEK
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Credential | MD
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Telephone | 317-660-5262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01063653A
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License Number State | IN
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