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General NPI Number Information
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NPI Number | 1881868347
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Entity Type | Individual
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Provider Name | MATTHEW MICHAEL FOURMAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 730 N MACOMB ST STE 415
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City | MONROE
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State | MI
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Zip | 48162-2904
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Country | US
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Telephone | 734-430-3200
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Fax | 734-430-3201
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Provider Business Mailing Address
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Address Line | 333 N SUMMIT ST
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City | TOLEDO
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State | OH
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Zip | 43604-1531
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Country | US
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Telephone | 734-430-3200
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Fax | 734-430-3201
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35.098301
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01075147A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301083501
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License Number State | MI
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