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General NPI Number Information
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NPI Number | 1841135266
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Entity Type | Organization
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Legal Business Name | PREVAIL MD PROFESSIONAL LLC
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 5199 SUE DR
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City | CARMEL
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State | IN
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Zip | 46033-8669
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Country | US
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Telephone | 317-441-8385
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Fax |
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Provider Business Mailing Address
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Address Line | 5199 SUE DR
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City | CARMEL
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State | IN
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Zip | 46033-8669
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Country | US
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Telephone | 317-441-8385
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GREGORY ROBERT PITTMAN
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Credential | MD
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Telephone | 317-441-8385
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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 |
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License Number State |
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