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General NPI Number Information
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NPI Number | 1780144709
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Entity Type | Individual
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Provider Name | MICHAEL PHAM DO
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Gender | Male
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 20905 GREENFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5360
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Country | US
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Telephone | 248-569-0296
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Fax |
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Provider Business Mailing Address
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Address Line | 26222 TELEGRAPH RD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-5318
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Country | US
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Telephone | 248-827-7200
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 5101026323
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5101026323
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License Number State | MI
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