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General NPI Number Information
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NPI Number | 1811481435
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Entity Type | Individual
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Provider Name | FAREEA KHALIQ MD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 261 MACK AVE
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City | DETROIT
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State | MI
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Zip | 48201-2417
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Country | US
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Telephone | 313-745-1203
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 VFW PKWY
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City | WEST ROXBURY
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State | MA
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Zip | 02132-4927
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Country | US
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Telephone |
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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 | 2081P0004X
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Taxonomy Name | Spinal Cord Injury Medicine Physician
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License Number | 1015240
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License Number State | MA
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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 | 1811481435
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License Number State | MI
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