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General NPI Number Information
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NPI Number | 1922358514
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Entity Type | Organization
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Legal Business Name | AUTHENTIC PLASTIC SURGERY, LLC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 11/12/2012
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Provider Practice Location Address
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Address Line | 2000 PLYMOUTH ROAD SUITE 300
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City | MINNETONKA
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State | MN
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Zip | 55305-2335
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Country | US
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Telephone | 612-360-6466
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 PLYMOUTH ROAD SUITE 260
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City | MINNETONKA
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State | MN
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Zip | 55305-2335
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Country | US
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Telephone | 612-360-6466
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Fax |
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Authorized Official
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Title or Position | MD
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Name | PAWEL STACHOWICZ
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Credential | MD
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Telephone | 612-360-6466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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