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General NPI Number Information
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NPI Number | 1598985350
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Entity Type | Organization
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Legal Business Name | PRODESSE, INC.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | W229N1870 WESTWOOD DR
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City | WAUKESHA
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State | WI
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Zip | 53186-1302
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Country | US
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Telephone | 262-446-0700
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Fax | 262-446-0600
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Provider Business Mailing Address
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Address Line | W229N1870 WESTWOOD DR
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City | WAUKESHA
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State | WI
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Zip | 53186-1302
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Country | US
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Telephone | 262-446-0700
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Fax | 262-446-0600
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. MICHAEL MIHALOV
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Credential | M.D.
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Telephone | 773-792-5046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 52D0906595
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License Number State | WI
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