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General NPI Number Information
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NPI Number | 1336487396
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Entity Type | Organization
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Legal Business Name | FREDERICK MICHAEL ELLIOTT, MD, PLLC
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Dates
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Enumeration Date | 01/26/2013
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Last Update Date | 01/26/2013
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Provider Practice Location Address
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Address Line | 897 DELAWARE AVE STE 205
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City | BUFFALO
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State | NY
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Zip | 14209-2087
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Country | US
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Telephone | 716-768-2006
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Fax | 716-768-2007
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Provider Business Mailing Address
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Address Line | 897 DELAWARE AVE STE 205
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City | BUFFALO
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State | NY
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Zip | 14209-2087
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Country | US
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Telephone | 716-768-2006
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Fax | 716-768-2007
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Authorized Official
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Title or Position | PHYSICIAN AND OWNER
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Name | FREDERICK MICHAEL ELLIOTT
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Credential | MD
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Telephone | 716-768-2006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 236287
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License Number State | NY
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