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General NPI Number Information
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NPI Number | 1629198007
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Entity Type | Organization
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Legal Business Name | CELESTINO M. PEREZ MD SC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 126 E PIER STREET
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-0006
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Country | US
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Telephone | 262-284-2636
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Fax | 262-284-2722
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Provider Business Mailing Address
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Address Line | 126 E PIER STREET P O BOX 6
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-0006
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Country | US
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Telephone | 262-284-2636
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Fax | 262-284-2722
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Authorized Official
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Title or Position | PRESIDENT
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Name | CELESTINO M PEREZ
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Credential | MD
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Telephone | 262-284-2636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20479
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License Number State | WI
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