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General NPI Number Information
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NPI Number | 1851188247
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Entity Type | Individual
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Provider Name | MICHAEL JANESIK
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Gender | Male
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 201 US ROUTE 7 S
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City | MILTON
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State | VT
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Zip | 05468-4570
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Country | US
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Telephone | 802-893-2717
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Fax |
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Provider Business Mailing Address
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Address Line | 4149 HIGHBRIDGE RD
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City | FAIRFAX
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State | VT
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Zip | 05454-5447
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Country | US
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Telephone | 802-318-5435
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 033.0134457INTN
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License Number State | VT
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