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General NPI Number Information
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NPI Number | 1720267982
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Entity Type | Organization
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Legal Business Name | ELIZABETH WENDE BREAST CARE LLC
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 170 SAWGRASS DR
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City | ROCHESTER
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State | NY
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Zip | 14620-4648
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Country | US
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Telephone | 585-758-7006
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Fax | 585-442-1837
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Provider Business Mailing Address
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Address Line | 170 SAWGRASS DR
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City | ROCHESTER
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State | NY
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Zip | 14620-4648
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Country | US
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Telephone | 585-758-7006
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Fax | 585-442-1837
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | ANNETTE WIEBELD
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Credential |
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Telephone | 585-442-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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