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General NPI Number Information
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NPI Number | 1548589021
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Entity Type | Individual
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Provider Name | STEPHEN MATTHEW DETZEL D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-2203
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Country | US
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Telephone | 216-444-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 6592 WESTPOINT DR
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City | HUDSON
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State | OH
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Zip | 44236-1604
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Country | US
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Telephone | 216-906-2725
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 34.011299
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License Number State | OH
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