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General NPI Number Information
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NPI Number | 1972584043
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Entity Type | Individual
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Provider Name | VAHID-DAVID SEDAGHAT M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 3512 STELLHORN RD
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City | FORT WAYNE
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State | IN
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Zip | 46815-4631
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Country | US
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Telephone | 260-483-9081
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Fax | 260-483-9196
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Provider Business Mailing Address
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Address Line | 330 N WABASH AVE STE G-20
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City | MARION
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State | IN
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Zip | 46952-2605
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Country | US
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Telephone | 765-660-7600
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Fax | 765-651-7313
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 01056095A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01056095A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 01056095A
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License Number State | IN
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