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General NPI Number Information
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NPI Number | 1538110648
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Entity Type | Individual
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Provider Name | MARK S MASSIE DPM
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 07/17/2010
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Provider Practice Location Address
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Address Line | 15644 MADISON AVE 106
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City | LAKEWOOD
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State | OH
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Zip | 44107-5622
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Country | US
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Telephone | 216-221-2445
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Fax | 216-221-5891
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Provider Business Mailing Address
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Address Line | PO BOX 40450
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City | BAY VILLAGE
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State | OH
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Zip | 44140-0450
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Country | US
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Telephone | 440-871-4700
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Fax | 440-871-4702
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 3600307M
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License Number State | OH
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