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General NPI Number Information
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NPI Number | 1730422726
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Entity Type | Individual
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Provider Name | INDERVIR SINGH MUNDH M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 2400 S 90TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227
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Country | US
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Telephone | 414-328-7146
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 S 90TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227
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Country | US
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Telephone | 414-328-7146
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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 | 140281
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 63945-20
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 63945-20
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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