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General NPI Number Information
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NPI Number | 1598817702
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Entity Type | Organization
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Legal Business Name | FOUR SEASONS MEDICAL CENTER, P.C.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 06/23/2017
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Provider Practice Location Address
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Address Line | 8683 CONNECTICUT ST SUITE B
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6388
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Country | US
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Telephone | 219-736-1022
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Fax | 219-769-7554
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Provider Business Mailing Address
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Address Line | 8683 CONNECTICUT ST SUITE B
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6388
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Country | US
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Telephone | 219-736-1022
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Fax | 219-769-7554
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN STEWART BROWN III
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Credential | M.D.
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Telephone | 219-736-1022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 01026202C
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License Number State | IN
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