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General NPI Number Information
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NPI Number | 1881143667
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Entity Type | Individual
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Provider Name | MR. MITCHELL BRIAN BERKENPAS
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Gender | Male
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 4382 14 MILE RD NE
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City | ROCKFORD
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State | MI
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Zip | 49341-7838
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Country | US
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Telephone | 888-258-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 9400 WESTVIEW DR SE
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City | BYRON CENTER
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State | MI
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Zip | 49315-9324
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Country | US
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Telephone | 616-877-0736
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302035517
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License Number State | MI
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