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General NPI Number Information
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NPI Number | 1669586582
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Entity Type | Individual
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Provider Name | MICHAEL ROLLI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 06/22/2013
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Provider Practice Location Address
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Address Line | SHAPE HCF UNIT 21414 BOX 153
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City | APO
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State | AE
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Zip | 09705
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Country | US
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Telephone | 0113265443321
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Fax | 0113265445882
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Provider Business Mailing Address
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Address Line | SHAPE HCF UNIT 21414 BOX 153
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City | APO
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State | AE
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Zip | 09705
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Country | US
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Telephone | 003265443321
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Fax | 03265445882
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD0000048561
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License Number State | TN
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