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General NPI Number Information
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NPI Number | 1356776215
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Entity Type | Organization
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Legal Business Name | CAINE INC
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 620 BELL ST
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City | WAUKESHA
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State | WI
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Zip | 53186-5172
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Country | US
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Telephone | 414-313-4652
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Fax |
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Provider Business Mailing Address
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Address Line | 11114 W MEQUANIGO DR
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City | WEST ALLIS
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State | WI
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Zip | 53227-3051
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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 | PRESIDENT
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Name | GLENN CAINE
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Credential |
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Telephone | 414-313-4652
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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 | 34605
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License Number State | WI
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