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General NPI Number Information
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NPI Number | 1649468364
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Entity Type | Organization
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Legal Business Name | SOUTH BEND VEIN CENTER FOR EXCELLLENCE, LLC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 2025 EDISON RD
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City | SOUTH BEND
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State | IN
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Zip | 46637-5599
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Country | US
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Telephone | 574-232-5831
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Fax | 574-968-0120
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Provider Business Mailing Address
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Address Line | 2025 EDISON RD SUITE B
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City | SOUTH BEND
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State | IN
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Zip | 46637-5599
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Country | US
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Telephone | 574-232-5831
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Fax | 574-968-0120
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN W OREN
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Credential | M.D.
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Telephone | 574-232-5831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 01030418A
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License Number State | IN
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