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General NPI Number Information
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NPI Number | 1972647386
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Entity Type | Individual
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Provider Name | MICHAEL FUNG MBCHB
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Gender | Male
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Dates
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Enumeration Date | 02/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3435 MAIN ST 160 FARBER HALL
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City | BUFFALO
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State | NY
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Zip | 14214-3001
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Country | US
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Telephone | 716-829-2070
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Fax |
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Provider Business Mailing Address
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Address Line | 95 SPRING MEADOW DR APT 19
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-8415
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Country | US
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Telephone | 716-632-6002
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Fax |
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 002696-1
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License Number State | NY
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