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General NPI Number Information
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NPI Number | 1841940905
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Entity Type | Organization
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Legal Business Name | SCOPE MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 50 N PERRY ST
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City | PONTIAC
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State | MI
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Zip | 48342-2217
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Country | US
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Telephone | 708-586-2080
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Fax |
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Provider Business Mailing Address
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Address Line | 6088 GLEN EAGLES DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-2212
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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 | OWNER
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Name | DR. MOHANAD SUEDE
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Credential | MD
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Telephone | 313-779-0406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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