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General NPI Number Information
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NPI Number | 1407496318
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Entity Type | Organization
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Legal Business Name | MICHAELBASTANIDPM
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 22 ODYSSEY STE 115
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City | IRVINE
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State | CA
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Zip | 92618-3188
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Country | US
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Telephone | 424-256-8956
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Fax |
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Provider Business Mailing Address
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Address Line | 23785 EL TORO RD # 450
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City | LAKE FOREST
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State | CA
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Zip | 92630-4762
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL BASTANI
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Credential | DPM
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Telephone | 917-675-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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