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General NPI Number Information
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NPI Number | 1417265349
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Entity Type | Organization
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Legal Business Name | PATEL FAMILYMEDICINE
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 1625 JEFFERSON AVE
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City | MISHAWAKA
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State | IN
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Zip | 46545
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Country | US
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Telephone | 574-255-1400
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Fax | 574-485-1781
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Provider Business Mailing Address
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Address Line | 1904 LAKE AVE
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City | PLYMOUTH
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State | IN
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Zip | 46563-7828
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Country | US
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Telephone | 574-936-3178
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Fax | 574-936-1084
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Authorized Official
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Title or Position | PHYSICIAN
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Name | VIRAJ PATEL
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Credential | M.D.
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Telephone | 574-936-3178
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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 | 01063921A
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License Number State | IN
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