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General NPI Number Information
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NPI Number | 1770548430
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH ELDEMIRE MD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 8442 DIXIE HWY
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City | LOUISVILLE
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State | KY
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Zip | 40258-1140
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Country | US
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Telephone | 502-638-4280
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Fax | 502-638-4281
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Provider Business Mailing Address
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Address Line | 2112 DOUGLASS BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40205-1902
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Country | US
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Telephone | 502-638-4280
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01053566A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 41336
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License Number State | KY
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