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General NPI Number Information
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NPI Number | 1962493643
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Entity Type | Individual
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Provider Name | EITAN MEDINI MD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 1900 CENTRA CARE CIR #1600 CENTRA CARE CLINIC HEALTH PLAZA / RADIATION ONCOLOGY
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City | ST CLOUD
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State | MN
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Zip | 56303-5000
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Country | US
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Telephone | 320-229-4901
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Fax | 320-229-5160
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Provider Business Mailing Address
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Address Line | 1900 CENTRA CARE CIR #1600 CENTRA CARE CLINIC HEALTH PLAZA / RADIATION ONCOLOGY
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City | ST CLOUD
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State | MN
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Zip | 56303-5000
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Country | US
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Telephone | 320-229-4901
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Fax | 320-229-5160
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 21866
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License Number State | MN
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