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General NPI Number Information
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NPI Number | 1649833013
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Entity Type | Individual
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Provider Name | ANDREW EDWARD ROSS
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Gender | Male
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Dates
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Enumeration Date | 04/20/2019
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 4160 JOHN R ST STE 1007
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City | DETROIT
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State | MI
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Zip | 48201-2017
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Country | US
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Telephone | 313-966-9471
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Fax | 313-966-9471
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Provider Business Mailing Address
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Address Line | 2342 JOHN R RD APT 105
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City | TROY
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State | MI
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Zip | 48083-2569
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Country | US
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Telephone | 619-261-4371
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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 | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 55101027692
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 5101027692
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License Number State | MI
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