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General NPI Number Information
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NPI Number | 1033270434
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PULMONARY MEDICINE, PSC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 234 EAST GRAY STREET SUITE 270
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City | LOUISVILLE
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State | KY
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Zip | 40202
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Country | US
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Telephone | 502-852-3772
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Fax | 502-852-4051
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Provider Business Mailing Address
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Address Line | 6801 DIXIE HIGHWAY SUITE 130
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City | LOUISVILLE
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State | KY
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Zip | 40258
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Country | US
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Telephone | 502-451-5855
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Fax | 502-479-1409
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Authorized Official
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Title or Position | OWNER OF PRACTICE
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Name | NEMR EID
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Credential | MD
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Telephone | 502-852-3772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 25574
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License Number State | KY
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