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General NPI Number Information
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NPI Number | 1306158985
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Entity Type | Individual
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Provider Name | SRINIVASA RAO GUDE RPT
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Gender | Male
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 340 ECORSE RD
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City | YPSILANTI
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State | MI
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Zip | 48198-5734
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Country | US
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Telephone | 734-483-1000
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Fax | 734-483-1010
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Provider Business Mailing Address
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Address Line | 5511 W US HIGHWAY 10 SUITE # B
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City | LUDINGTON
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State | MI
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Zip | 49431-2455
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Country | US
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Telephone | 231-845-0900
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Fax | 231-845-0909
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501014309
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License Number State | MI
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