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General NPI Number Information
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NPI Number | 1508661760
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Entity Type | Individual
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Provider Name | NICHOLAS DIROFF PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 29877 TELEGRAPH RD STE 401
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City | SOUTHFIELD
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State | MI
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Zip | 48034-7661
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Country | US
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Telephone | 248-651-8344
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Fax |
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Provider Business Mailing Address
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Address Line | 14728 OLD TOWN CT
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City | RIVERVIEW
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State | MI
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Zip | 48193-7711
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601012927
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License Number State | MI
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