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General NPI Number Information
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NPI Number | 1366575839
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Entity Type | Individual
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Provider Name | MANOO BOONSIRI M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10501 TELEGRAPH RD SUITE 102
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City | TAYLOR
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State | MI
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Zip | 48180-3375
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Country | US
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Telephone | 313-295-7822
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Fax | 734-241-3350
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Provider Business Mailing Address
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Address Line | 730 N MACOMB ST SUITE 415
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City | MONROE
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State | MI
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Zip | 48162-2900
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Country | US
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Telephone | 734-243-5822
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Fax | 734-241-3350
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 35446
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License Number State | MI
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