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1003873183 NPI number — BORIS V KLOPUKH MD

NPI Number: 1003873183
Health Care Provider/Practitioner: BORIS V KLOPUKH MD

Information about “1003873183” NPI (BORIS V KLOPUKH MD) exists in 1003873183 in HTML format HTML  |  1003873183 in plain Text format TXT  |  1003873183 in PDF (Portable Document Format) PDF  |  1003873183 in an XML format XML  formats.

NPI Number : 1003873183 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003873183",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KLOPUKH",
    "FirstName": "BORIS",
    "MiddleName": "V",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2234 COLONIAL BLVD",
    "SecondLineMailingAddress": "ATTN: PAYER CONTRACTING & RELATIONS DEPT.",
    "MailingAddressCityName": "FORT MYERS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33907-1412",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "239-931-7342",
    "MailingAddressFaxNumber": "239-931-7385",
    "FirstLinePracticeLocationAddress": "21110 BISCAYNE BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 201",
    "PracticeLocationAddressCityName": "AVENTURA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33180-1227",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-534-4747",
    "PracticeLocationAddressFaxNumber": "305-937-7726",
    "EnumerationDate": "05/01/2006",
    "LastUpdateDate": "10/06/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208800000X",
        "TaxonomyName": "Urology Physician",
        "LicenseNumber": "ME82314",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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