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General NPI Number Information
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NPI Number | 1619306131
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Entity Type | Individual
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Provider Name | MR. MICHAEL STEWART
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Gender | Male
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 495 NW DEPOT ST
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City | DURANT
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State | MS
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Zip | 39063-3705
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Country | US
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Telephone | 662-392-1064
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 343
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City | DURANT
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State | MS
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Zip | 39063-0343
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Country | US
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Telephone | 662-392-1064
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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