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General NPI Number Information
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NPI Number | 1629281068
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Entity Type | Organization
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Legal Business Name | BIOLIGHT THERAPEUTICS LLC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 15600 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48235-2928
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Country | US
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Telephone | 248-456-0619
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Fax | 248-456-0729
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Provider Business Mailing Address
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Address Line | 15600 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48235-2928
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Country | US
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Telephone | 248-456-0619
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Fax | 248-456-0729
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Authorized Official
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Title or Position | DIRECTOR
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Name | JASON SMITH
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Credential |
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Telephone | 248-456-0619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 4301034892
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License Number State | MI
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