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General NPI Number Information
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NPI Number | 1447431119
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Entity Type | Organization
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Legal Business Name | MICHAEL J WOLOSCHAK OD INC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 2670 S RACCOON RD SUITE #1
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City | YOUNGSTOWN
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State | OH
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Zip | 44515-5380
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Country | US
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Telephone | 330-799-3937
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Fax | 330-799-1557
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Provider Business Mailing Address
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Address Line | 2670 S RACCOON RD SUITE #1
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City | YOUNGSTOWN
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State | OH
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Zip | 44515-5380
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Country | US
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Telephone | 330-799-3937
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Fax | 330-799-1557
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL J WOLOSCHAK
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Credential | O.D.
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Telephone | 330-799-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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