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General NPI Number Information
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NPI Number | 1902393721
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Entity Type | Individual
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Provider Name | MICHAEL DOMINIC RENECLE DO
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Gender | Male
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 45 CASTRO ST STE 421
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-1031
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Country | US
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Telephone | 415-600-4900
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Fax | 412-536-9124
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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Country | US
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Telephone | 415-600-4900
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Fax | 415-369-1367
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A22036
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License Number State | CA
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