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General NPI Number Information
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NPI Number | 1437322823
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Entity Type | Individual
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Provider Name | SOLFIA MEDINA SAULOG M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 1800 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3810
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Country | US
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Telephone | 217-464-2870
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Fax | 217-464-1616
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Provider Business Mailing Address
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Address Line | 4075 COPPER RIDGE DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7059
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Country | US
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Telephone | 888-632-0543
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Fax | 231-932-4204
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | IL
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