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General NPI Number Information
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NPI Number | 1528359676
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Entity Type | Organization
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Legal Business Name | SOUTHEAST HOSPITALISTS
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 21230 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48091-2279
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Country | US
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Telephone | 248-535-0025
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Fax | 248-932-8977
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Provider Business Mailing Address
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Address Line | 3061 CHRISTY WAY
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City | SAGINAW
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State | MI
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Zip | 48603-2224
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Country | US
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Telephone | 989-791-2455
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Fax | 989-791-1392
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Authorized Official
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Title or Position | OWNER
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Name | ELLIOTTE MOSS
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Credential | MD
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Telephone | 248-535-0025
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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 | 4301029998
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License Number State | MI
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