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General NPI Number Information
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NPI Number | 1558359596
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Entity Type | Individual
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Provider Name | MAHENDER MACHA MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 1100 E MICHIGAN AVE SUITE 301
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City | JACKSON
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State | MI
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Zip | 49201-1847
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Country | US
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Telephone | 517-817-7605
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Fax | 517-817-7606
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Provider Business Mailing Address
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Address Line | PO BOX 67000 DEPARTMENT 272801
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City | DETROIT
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State | MI
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Zip | 48267-0002
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Country | US
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Telephone | 517-817-7605
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Fax | 517-817-7606
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD050898L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 4301064881
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License Number State | MI
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