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General NPI Number Information
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NPI Number | 1427495878
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Entity Type | Organization
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Legal Business Name | INDIAN CREEK FAMILY HEALTH BROOKVILLE LLC
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 617 MAIN ST
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City | BROOKVILLE
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State | IN
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Zip | 47012-1280
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Country | US
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Telephone | 765-647-4231
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Fax | 765-547-1414
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Provider Business Mailing Address
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Address Line | 617 MAIN ST
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City | BROOKVILLE
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State | IN
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Zip | 47012-1280
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Country | US
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Telephone | 765-647-4231
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Fax | 765-547-1414
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PHYSICIAN
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Name | DR. MICHAEL FAIN
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Credential | D.O.
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Telephone | 765-647-4231
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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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