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General NPI Number Information
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NPI Number | 1700048832
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Entity Type | Organization
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Legal Business Name | MARCO K MICHELSON, MD, PC
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 1051 PORT WASHINGTON BLVD NO 766
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-2941
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Country | US
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Telephone | 917-771-2111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 766
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-0766
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Country | US
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Telephone | 917-771-2111
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARCO K MICHELSON
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Credential | MD
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Telephone | 917-771-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 188110
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License Number State | NY
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