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General NPI Number Information
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NPI Number | 1285064881
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Entity Type | Organization
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Legal Business Name | UNITED MEDICAL CLINIC
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 21800 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48219-1897
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Country | US
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Telephone | 248-885-4319
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Fax |
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Provider Business Mailing Address
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Address Line | 21800 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48219-1897
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Country | US
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Telephone | 248-885-4319
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES B BURDETTE
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Credential | PA-C
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Telephone | 248-885-4319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5601002272
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License Number State | MI
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