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General NPI Number Information
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NPI Number | 1932094752
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL INTEGRATIVE CARE LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 4018 N HAMPTON DR
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City | POWELL
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State | OH
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Zip | 43065-8431
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Country | US
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Telephone | 614-618-0017
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Fax | 614-635-9229
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Provider Business Mailing Address
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Address Line | 4018 N HAMPTON DR
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City | POWELL
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State | OH
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Zip | 43065-8431
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Country | US
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Telephone | 614-618-0017
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Fax | 614-635-9229
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DANIEL FOSSELMAN
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Credential | DO
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Telephone | 614-499-6863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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