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General NPI Number Information
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NPI Number | 1356332977
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Entity Type | Individual
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Provider Name | KEVIN JEREMY MCAWARD M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 111 W JEFFERSON BLVD STE. 100
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City | SOUTH BEND
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State | IN
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Zip | 46601-1994
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Country | US
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Telephone | 574-647-1669
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Fax | 574-239-6461
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Provider Business Mailing Address
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Address Line | 3355 DOUGLAS RD STE. 300
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City | SOUTH BEND
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State | IN
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Zip | 46635-1781
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01058339A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 01058339A
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License Number State | IN
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