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General NPI Number Information
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NPI Number | 1700866811
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Entity Type | Organization
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Legal Business Name | PHYSICIANS RESIDENTIAL SERVICES, P.C.
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 20927 KELLY RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-3128
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Country | US
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Telephone | 586-777-8801
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Fax | 586-777-9988
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Provider Business Mailing Address
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Address Line | 20927 KELLY RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-3128
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Country | US
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Telephone | 586-777-8801
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Fax | 586-777-9988
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWIN J SOLER-VALCOURT
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Credential | M.D.
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Telephone | 586-777-8801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301068676
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License Number State | MI
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