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General NPI Number Information
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NPI Number | 1932387099
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Entity Type | Individual
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Provider Name | JOHN MICHAEL KORZELIUS MD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 692 CRESTVIEW AVE
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City | CAMARILLO
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State | CA
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Zip | 93010-7477
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Country | US
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Telephone | 805-890-5991
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Fax | 805-383-9663
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Provider Business Mailing Address
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Address Line | 692 CRESTVIEW AVE
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City | CAMARILLO
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State | CA
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Zip | 93010-7477
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Country | US
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Telephone | 805-890-5991
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Fax | 805-383-9663
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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 | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | G49388
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License Number State | CA
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