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General NPI Number Information
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NPI Number | 1770542441
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Entity Type | Individual
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Provider Name | KENNETH SAMUEL STONE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 1116 N 16TH ST SUITE A
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City | LAFAYETTE
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State | IN
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Zip | 47904-2119
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Country | US
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Telephone | 765-448-8000
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Fax | 765-448-8054
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Provider Business Mailing Address
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Address Line | PO BOX 5545
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City | LAFAYETTE
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State | IN
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Zip | 47903-5545
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Country | US
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Telephone | 765-448-8000
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Fax | 765-448-8085
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 01036689A
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License Number State | IN
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