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General NPI Number Information
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NPI Number | 1073003745
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Entity Type | Organization
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Legal Business Name | CORELIFE INC
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 3829 LORNA RD STE 312
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City | HOOVER
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State | AL
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Zip | 35244-7058
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Country | US
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Telephone | 205-710-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 BENFIELD BLVD STE 250
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City | MILLERSVILLE
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State | MD
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Zip | 21108-3005
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Country | US
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Telephone | 443-679-4309
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Fax | 855-772-4748
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Authorized Official
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Title or Position | CEO
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Name | RAYMOND KOSTKOWSKI
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Credential |
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Telephone | 410-991-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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