Basic Information
Provider Information
NPI: 1497205546
EntityType: 2
ReplacementNPI:  
OrganizationName: CAPITOL INFECTIOUS DISEASE ASSOCIATES
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Mailing Information
Address1: 6200 PINE HOLLOW DR STE 400
Address2:  
City: EAST LANSING
State: MI
PostalCode: 488239224
CountryCode: US
TelephoneNumber: 5173391676
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Practice Location
Address1: 6401 PINE HOLLOW DR
Address2:  
City: EAST LANSING
State: MI
PostalCode: 488239737
CountryCode: US
TelephoneNumber: 5173391676
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/12/2016
LastUpdateDate: 12/12/2016
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AuthorizedOfficialLastName: ABBAS
AuthorizedOfficialFirstName: MUJAHED
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AuthorizedOfficialTitleorPosition: OWNER / AUTHORIZED OFFICIAL
AuthorizedOfficialTelephone: 5173391676
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X4301054596MIY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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