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General NPI Number Information
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NPI Number | 1447432794
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Entity Type | Organization
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Legal Business Name | LIVONIA PALLIATIVE CARE P.L.L.C.
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 14100 NEWBURGH RD
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City | LIVONIA
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State | MI
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Zip | 48154-5010
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Country | US
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Telephone | 724-953-6033
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Fax | 734-464-2035
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Provider Business Mailing Address
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Address Line | 14100 NEWBURGH RD
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City | LIVONIA
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State | MI
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Zip | 48154-5010
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Country | US
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Telephone | 724-953-6033
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES SCOTT BOAL
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Credential | M.D.
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Telephone | 734-953-6033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 4301070040
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License Number State | MI
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