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General NPI Number Information
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NPI Number | 1700205911
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Entity Type | Individual
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Provider Name | MICHAEL CUPAK D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 1400 8TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104
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Country | US
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Telephone | 817-926-2544
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CROSSLANDS RD
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City | BENBROOK
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State | TX
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Zip | 76132-1007
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Country | US
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Telephone | 801-404-1220
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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 | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | R1942
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License Number State | TX
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