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General NPI Number Information
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NPI Number | 1346355179
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Entity Type | Individual
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Provider Name | MATTHEW H EVENHOUSE MD
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1991 CROCKER RD STE 500
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City | WESTLAKE
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State | OH
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Zip | 44145-1962
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Country | US
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Telephone | 844-764-4633
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Fax | 310-861-0855
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Provider Business Mailing Address
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Address Line | 304 RUTH ST
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City | BAY VILLAGE
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State | OH
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Zip | 44140-1228
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Country | US
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Telephone | 614-902-0771
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 35082452
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35082452
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License Number State | OH
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