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General NPI Number Information
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NPI Number | 1467573063
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Entity Type | Organization
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Legal Business Name | CIRCLE CITY MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3850 SHORE DR SUITE 113
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5621
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Country | US
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Telephone | 317-298-0000
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Fax | 317-398-0011
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Provider Business Mailing Address
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Address Line | 3850 SHORE DR SUITE 113
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5621
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Country | US
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Telephone | 317-298-0000
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Fax | 317-398-0011
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. ANGELA LYNN JOHNSON
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Credential | M.D.
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Telephone | 317-298-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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