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General NPI Number Information
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NPI Number | 1588310189
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Entity Type | Individual
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Provider Name | MARK GAUT
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Gender | Male
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 3630 CAPITAL AVE SW STE 5
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City | BATTLE CREEK
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State | MI
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Zip | 49015-7376
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Country | US
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Telephone | 269-979-7822
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Fax |
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Provider Business Mailing Address
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Address Line | 8312 PARKRIDGE DR
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City | DEXTER
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State | MI
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Zip | 48130-9397
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Country | US
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Telephone | 734-516-8464
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302028964
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License Number State | MI
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