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General NPI Number Information
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NPI Number | 1275062507
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Entity Type | Individual
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Provider Name | SHIRISH POUDYAL MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 2555 E 13TH STE STE 220
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City | LOVELAND
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State | CO
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Zip | 80537-5097
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Country | US
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Telephone | 970-669-5432
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Fax | 970-207-1893
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Provider Business Mailing Address
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Address Line | 1500 E MEDICAL CENTER DR # TC3116
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City | ANN ARBOR
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State | MI
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Zip | 48109-5000
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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 |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 70344
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License Number State | CO
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