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General NPI Number Information
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NPI Number | 1831290402
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Entity Type | Individual
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Provider Name | JILL L STEPHENSON-MCCOLE MD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 2040 AURELIUS RD
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City | HOLT
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State | MI
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Zip | 48842-1367
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Country | US
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Telephone | 517-694-2217
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Fax | 517-694-2655
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Provider Business Mailing Address
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Address Line | PO BOX 13008
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City | LANSING
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State | MI
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Zip | 48901-3008
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Country | US
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Telephone | 517-645-0000
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Fax | 517-645-4559
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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 | 4301093889
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License Number State | MI
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