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General NPI Number Information
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NPI Number | 1881875540
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Entity Type | Organization
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Legal Business Name | INDIANA CENTER FOR HEALTH AND NUTRITION
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 7440 N SHADELAND AVE SUITE 206
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2029
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Country | US
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Telephone | 317-577-5590
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Fax |
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Provider Business Mailing Address
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Address Line | 7440 N SHADELAND AVE SUITE 206
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2029
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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. RASHID KHAIRI
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Credential |
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Telephone | 317-577-5590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 01025488A
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License Number State | IN
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