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General NPI Number Information
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NPI Number | 1700263134
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Entity Type | Individual
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Provider Name | MAYANK PATEL
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Gender | Male
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 1300 W TERRELL AVE STE K230
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City | FORT WORTH
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State | TX
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Zip | 76104-3104
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Country | US
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Telephone | 817-250-4906
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 ARMSTRONG RD
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City | BATTLE CREEK
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State | MI
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Zip | 49037-7314
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N608565
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | S2454
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License Number State | TX
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