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General NPI Number Information
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NPI Number | 1679732663
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Entity Type | Individual
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Provider Name | KATIE JO STANTON-MAXEY MD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 720 ESKENAZI AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5166
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Country | US
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Telephone | 317-880-5048
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE STE 130 PROVIDER ENROLLMENT
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone | 317-963-0860
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01062144A
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License Number State | IN
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