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General NPI Number Information
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NPI Number | 1740991967
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Entity Type | Individual
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Provider Name | MICHAEL SCOTT CAMPBELL
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Gender | Male
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 916 RAVINE DR
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City | FRANKLIN
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State | IN
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Zip | 46131-3609
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Country | US
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Telephone | 574-540-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 707 S BOWER ST
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City | KNOX
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State | IN
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Zip | 46534-1906
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Country | US
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Telephone | 574-540-3655
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | 0750-08-0724
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License Number State | IN
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