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General NPI Number Information
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NPI Number | 1801104153
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Entity Type | Individual
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Provider Name | KELLY L KESTI O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 56901 S 6TH ST STE. 1
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City | CALUMET
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State | MI
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Zip | 49913-2946
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Country | US
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Telephone | 906-337-5252
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Fax | 906-337-5254
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Provider Business Mailing Address
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Address Line | 56901 S 6TH ST STE. 1
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City | CALUMET
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State | MI
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Zip | 49913-2946
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Country | US
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Telephone | 906-337-5252
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Fax | 906-337-5254
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004670
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3201
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License Number State | WI
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