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General NPI Number Information
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NPI Number | 1295141380
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Entity Type | Organization
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Legal Business Name | GYNECOLOGIC ONCOLOGY OF NORTHEAST INDIANA, LLC
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 1818 CAREW ST SUITE 250
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City | FORT WAYNE
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State | IN
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Zip | 46805-4788
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Country | US
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Telephone | 260-437-4789
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 307
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City | ROANOKE
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State | IN
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Zip | 46783-0307
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Country | US
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Telephone | 260-437-4789
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | IWONA PODZIELINSKI
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Credential | MD
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Telephone | 260-437-4789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State | IN
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