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General NPI Number Information
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NPI Number | 1861574204
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Entity Type | Individual
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Provider Name | JONATHAN RENE MD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 1015 S WASHINGTON AVE
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City | SAGINAW
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State | MI
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Zip | 48601-2556
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Country | US
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Telephone | 989-746-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 2172 HEMMETER ROAD
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City | SAGINAW
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State | MI
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Zip | 48603
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Country | US
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Telephone | 989-790-8445
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Fax | 989-790-6977
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 4301057637
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License Number State | MI
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