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General NPI Number Information
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NPI Number | 1942674155
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Entity Type | Organization
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Legal Business Name | GASTROINTESTINAL AND LIVER DISEASE SPECIALISTS PC
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 11/25/2015
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Provider Practice Location Address
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Address Line | 44201 DEQUINDRE RD
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City | TROY
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State | MI
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Zip | 48085-1117
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Country | US
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Telephone | 248-953-3617
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 829
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City | BLOOMFLD HLS
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State | MI
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Zip | 48303-0829
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Country | US
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Telephone | 248-953-3617
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WAEL REFAI
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Credential |
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Telephone | 248-953-3617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301095430
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License Number State | MI
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