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General NPI Number Information
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NPI Number | 1548226384
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Entity Type | Organization
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Legal Business Name | MEDIC INFUSION INC
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 1441 TAMIAMI TRL SUITE 341
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1098
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Country | US
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Telephone | 941-613-1919
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Fax | 941-613-4077
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Provider Business Mailing Address
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Address Line | 1441 TAMIAMI TRL SUITE 341
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1098
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Country | US
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Telephone | 941-613-1919
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Fax | 941-613-4077
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHEAL R METYK
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Credential | DPM
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Telephone | 941-613-1919
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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 | PO2884
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License Number State | FL
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