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General NPI Number Information
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NPI Number | 1396780573
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Entity Type | Organization
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Legal Business Name | DEMOTTE PHYSICIANS INC.
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 520 8TH AVE NE
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City | DEMOTTE
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State | IN
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Zip | 46310-9108
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Country | US
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Telephone | 219-987-3581
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Fax | 219-987-7137
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Provider Business Mailing Address
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Address Line | PO BOX 20
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City | DEMOTTE
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State | IN
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Zip | 46310-0020
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Country | US
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Telephone | 219-987-3581
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Fax | 219-987-7137
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID VANDER LUGT
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Credential | M.D.
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Telephone | 219-987-3581
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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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