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General NPI Number Information
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NPI Number | 1396217600
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Entity Type | Organization
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Legal Business Name | JUDSON CENTER, INC.
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 12200 E 13 MILE RD
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City | WARREN
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State | MI
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Zip | 48093-3093
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Country | US
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Telephone | 586-573-1810
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Fax |
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Provider Business Mailing Address
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Address Line | 4410 W 13 MILE RD
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City | ROYAL OAK
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State | MI
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Zip | 48073-6515
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Country | US
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Telephone | 586-573-1810
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REIMBURSEMENT
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Name | KRISTIN C DESJARDINS
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Credential |
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Telephone | 248-554-6358
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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 |
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License Number State |
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