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General NPI Number Information
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NPI Number | 1891971693
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Entity Type | Organization
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Legal Business Name | THOMAS MATHEW MD PLLC
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 35 S JOHNSON ST 1A
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City | PONTIAC
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State | MI
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Zip | 48341-1658
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Country | US
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Telephone | 248-334-4721
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Fax | 248-334-3585
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Provider Business Mailing Address
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Address Line | 35 S JOHNSON ST 1A
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City | PONTIAC
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State | MI
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Zip | 48341-1658
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Country | US
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Telephone | 248-334-4721
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Fax | 248-334-3585
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS MATHEW
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Credential | M.D.
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Telephone | 248-334-4721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | TM031410
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License Number State | MI
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