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General NPI Number Information
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NPI Number | 1689888257
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Entity Type | Individual
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Provider Name | MICHAEL WYCOKI JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8156 SE GOVERNORS WAY
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City | HOBE SOUND
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State | FL
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Zip | 33455-3945
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Country | US
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Telephone | 772-486-3092
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Fax | 772-546-0657
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Provider Business Mailing Address
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Address Line | 8156 SE GOVERNORS WAY
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City | HOBE SOUND
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State | FL
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Zip | 33455-3945
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Country | US
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Telephone | 772-486-3092
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Fax | 772-546-0657
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3082
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License Number State | FL
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