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General NPI Number Information
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NPI Number | 1396085569
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Entity Type | Organization
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Legal Business Name | RELEVARE GROUP INCORPORATED
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 1287 FULTON RD
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City | SANTA ROSA
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State | CA
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Zip | 95401-4923
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Country | US
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Telephone | 707-888-5808
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Fax | 707-577-8315
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Provider Business Mailing Address
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Address Line | PO BOX 1770
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City | LA MESA
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State | CA
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Zip | 91944-1770
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Country | US
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Telephone | 619-464-1165
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Fax | 619-567-1011
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL LEE MEDVIN
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Credential | M.D.
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Telephone | 707-888-5808
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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 | A0736012
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License Number State | CA
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