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General NPI Number Information
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NPI Number | 1407112014
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Entity Type | Individual
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Provider Name | SCOTT MICHAEL LEYKAUF CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 826 W KING ST
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City | OWOSSO
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State | MI
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Zip | 48867-2120
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Country | US
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Telephone | 989-729-4817
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Fax |
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Provider Business Mailing Address
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Address Line | 10 COMMERCE DR
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5253
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Country | US
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Telephone | 914-365-6128
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704202915
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License Number State | MI
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