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General NPI Number Information
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NPI Number | 1962677781
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Entity Type | Organization
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Legal Business Name | MUSSA BANISADRE MD INC
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 1325 MELROSE AVE SUITE A
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City | MODESTO
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State | CA
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Zip | 95350-5581
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Country | US
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Telephone | 209-527-5601
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 MELROSE AVE SUITE A
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City | MODESTO
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State | CA
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Zip | 95350-5581
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Country | US
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Telephone | 209-527-5601
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Fax |
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Authorized Official
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Title or Position | MD OWNER
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Name | MR. MUSSA BANISADRE
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Credential | MD INC
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Telephone | 209-524-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | A38740
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License Number State | CA
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