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General NPI Number Information
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NPI Number | 1801061957
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Entity Type | Organization
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Legal Business Name | PONNIAH MOHAN MD PC
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 11446 E 13 MILE RD SUITE B
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City | WARREN
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State | MI
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Zip | 48093-6571
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Country | US
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Telephone | 586-574-2020
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Fax | 586-574-2919
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Provider Business Mailing Address
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Address Line | 11446 E 13 MILE RD SUITE B
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City | WARREN
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State | MI
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Zip | 48093-6571
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Country | US
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Telephone | 586-574-2020
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Fax | 586-574-2919
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PONNIAH MOHAN
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Credential | MD
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Telephone | 586-574-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | PM039179
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License Number State | MI
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