Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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NPI 1568308773

Individual provider · NPI 1568308773 Deactivated

This NPI was deactivated on October 22, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1568308773 is listed in the national NPI registry.

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Record details

NPI number1568308773
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—