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General NPI Number Information
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NPI Number | 1285974790
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Entity Type | Organization
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Legal Business Name | SAINT JOSEPH CLINIC PC
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Dates
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Enumeration Date | 02/20/2013
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 23077 GREENFIELD RD SUITE#240
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3709
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Country | US
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Telephone | 248-809-6402
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Fax | 248-537-3012
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Provider Business Mailing Address
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Address Line | 23077 GREENFIELD RD SUITE#240
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3709
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Country | US
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Telephone | 248-809-6402
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Fax | 248-537-3012
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SRINIVASULU REDDY
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Credential |
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Telephone | 248-809-6402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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