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General NPI Number Information
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NPI Number | 1497137327
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Entity Type | Individual
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Provider Name | ANDREW KANAREK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2015
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 309 W WASHINGTON AVE UNIT 208
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City | MADISON
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State | WI
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Zip | 53703-3590
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Country | US
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Telephone | 857-234-0221
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Fax |
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Provider Business Mailing Address
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Address Line | 309 W WASHINGTON AVE UNIT 208
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City | MADISON
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State | WI
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Zip | 53703-3590
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Country | US
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Telephone |
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 6428-851
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 68135-20
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License Number State | WI
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