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General NPI Number Information
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NPI Number | 1306016654
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Entity Type | Organization
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Legal Business Name | RHEUMATOLOGY AND IMMUNOTHERAPY CENTER
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 7401 104TH AVE SUITE 110
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City | KENOSHA
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State | WI
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Zip | 53142
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Country | US
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Telephone | 414-768-0940
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Fax |
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Provider Business Mailing Address
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Address Line | 200 E RYAN RD SUITE 101
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City | OAK CREEK
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State | WI
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Zip | 53154-4533
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Country | US
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Telephone | 414-768-0940
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ALVIN F WELLS
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Credential | MD
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Telephone | 414-768-0940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 46013
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License Number State | WI
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