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General NPI Number Information
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NPI Number | 1932112539
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Entity Type | Organization
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Legal Business Name | MICHAEL MOHANDESON, MD PS
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 10564 5TH AVE NE SUITE 301
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City | SEATTLE
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State | WA
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Zip | 98125
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Country | US
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Telephone | 206-365-1100
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Fax | 206-365-1118
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Provider Business Mailing Address
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Address Line | 10564 5TH AVE NE SUITE 301
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City | SEATTLE
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State | WA
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Zip | 98125
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Country | US
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Telephone | 206-365-1100
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Fax | 206-365-1118
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Authorized Official
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Title or Position | CORPORATION PRESIDENT
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Name | DR. MICHAEL M MOHANDESON
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Credential | MD
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Telephone | 206-365-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 16823
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License Number State | WA
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