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General NPI Number Information
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NPI Number | 1043470073
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Entity Type | Organization
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Legal Business Name | MEDAMAX, LLC
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 550 NE 125TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-4755
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Country | US
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Telephone | 305-733-3571
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Fax |
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Provider Business Mailing Address
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Address Line | 12000 BISCAYNE BLVD SUITE 601
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2735
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Country | US
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Telephone | 305-733-3577
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Fax | 305-933-1021
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. ALAN DORNE
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Credential |
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Telephone | 305-733-3577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 408555-1
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License Number State | FL
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