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General NPI Number Information
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NPI Number | 1902337835
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Entity Type | Individual
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Provider Name | EDWARD JOSEPH KANIVE D.O
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Gender | Male
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 5165 MCCARTY LN
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City | LAFAYETTE
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State | IN
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Zip | 47905-8764
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Country | US
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Telephone | 765-488-8000
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Fax | 765-868-4698
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Provider Business Mailing Address
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Address Line | 1200 W WHITE RIVER BLVD
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City | MUNCIE
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State | IN
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Zip | 47303-4988
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Country | US
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Telephone | 765-747-4492
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Fax | 317-222-2126
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125069970
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 02005998A
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License Number State | IN
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