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General NPI Number Information
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NPI Number | 1548210628
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Entity Type | Individual
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Provider Name | ANGELA HALIBURDA D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 1260 32ND AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1649
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Country | US
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Telephone | 320-230-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 226 CAVIL WAY
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City | DE PERE
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State | WI
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Zip | 54115-3772
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Country | US
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Telephone | 920-351-0289
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 48462
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License Number State | MN
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