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General NPI Number Information
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NPI Number | 1942867429
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Entity Type | Organization
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Legal Business Name | MTG CAPITAL LLC
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 13277 ILLINOIS ST STE 100
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City | CARMEL
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State | IN
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Zip | 46032-8601
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Country | US
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Telephone | 262-751-1434
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Fax |
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Provider Business Mailing Address
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Address Line | 17360 WEST LN
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City | BROOKFIELD
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State | WI
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Zip | 53045-4333
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Country | US
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Telephone | 262-751-1434
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MATTHEW THOMAS GESKE
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Credential |
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Telephone | 262-751-1434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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