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General NPI Number Information
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NPI Number | 1316459787
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Entity Type | Organization
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Legal Business Name | MICHAEL R. COSENZA, DPM, INC.
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 238 HOSPITAL DR STE B
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City | UKIAH
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State | CA
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Zip | 95482-4559
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Country | US
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Telephone | 707-463-3668
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Fax | 707-463-3664
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Provider Business Mailing Address
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Address Line | 238 HOSPITAL DR STE B
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City | UKIAH
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State | CA
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Zip | 95482-4559
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Country | US
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Telephone | 707-463-3668
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Fax | 707-463-3664
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Authorized Official
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Title or Position | CREDENTIALING ACCOUNT MANAGER
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Name | KELLIE HAWKINS
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Credential |
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Telephone | 210-298-6847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | E4380
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License Number State | CA
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