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General NPI Number Information
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NPI Number | 1972205656
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Entity Type | Organization
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Legal Business Name | MAI MEDICAL
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 4807 SUGAR GROVE BLVD STE 302
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City | STAFFORD
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State | TX
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Zip | 77477-2654
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Country | US
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Telephone | 713-999-2860
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Fax | 713-999-2689
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Provider Business Mailing Address
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Address Line | 4807 SUGAR GROVE BLVD STE 302
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City | STAFFORD
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State | TX
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Zip | 77477-2654
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Country | US
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Telephone | 713-999-2860
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Fax | 713-999-2699
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Authorized Official
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Title or Position | MANAGER
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Name | MONICA TREVINO
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Credential |
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Telephone | 832-604-9944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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