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General NPI Number Information
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NPI Number | 1366097016
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Entity Type | Organization
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Legal Business Name | MIDS, LLC
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 3838 N MAIN ST STE 1C
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City | MISHAWAKA
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State | IN
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Zip | 46545-3100
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Country | US
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Telephone | 574-404-3980
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Fax | 574-931-8601
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Provider Business Mailing Address
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Address Line | 3838 N MAIN ST STE 1C
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City | MISHAWAKA
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State | IN
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Zip | 46545-3100
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Country | US
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Telephone | 574-404-3980
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Fax | 574-931-8601
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LLOYD SCHULMAN
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Credential |
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Telephone | 574-286-6802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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