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General NPI Number Information
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NPI Number | 1891735734
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Entity Type | Individual
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Provider Name | SCOTT A LAKER MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 5807 W MAPLE RD STE 175
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4483
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Country | US
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Telephone | 248-255-4380
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Fax | 248-255-4381
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Provider Business Mailing Address
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Address Line | PO BOX 251742
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48325-1742
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Country | US
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Telephone | 248-255-4380
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Fax | 248-255-4381
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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 | 4301086396
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License Number State | MI
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