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General NPI Number Information
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NPI Number | 1629384144
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Entity Type | Organization
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Legal Business Name | EAST SIDE MEDICAL SERVICES P C
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Dates
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Enumeration Date | 08/21/2010
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 22790 HARPER AVE SUITE A
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1831
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Country | US
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Telephone | 586-445-3070
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Fax | 586-445-3072
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Provider Business Mailing Address
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Address Line | 22790 HARPER AVE SUITE A
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1831
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Country | US
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Telephone | 586-445-3070
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Fax | 586-445-3072
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MOHD S JAFRI
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Credential | M.D.
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Telephone | 586-445-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301031532
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License Number State | MI
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