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General NPI Number Information
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NPI Number | 1467313551
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Entity Type | Organization
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Legal Business Name | MOONEY MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 1055 MEDICAL PARK DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8323
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Country | US
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Telephone | 616-942-9610
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Fax |
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Provider Business Mailing Address
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Address Line | 13159 HARBORVIEW DR
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City | LINDEN
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State | MI
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Zip | 48451-9496
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Country | US
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Telephone | 810-691-7513
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DYLAN MOONEY
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Credential | DO
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Telephone | 810-691-7513
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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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