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General NPI Number Information
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NPI Number | 1073407227
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Entity Type | Organization
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Legal Business Name | COMPLEXCARE MEDICAL GROUP KANSAS H LLC
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 41800 W 11 MILE RD STE 109
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City | NOVI
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State | MI
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Zip | 48375-1818
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Country | US
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Telephone | 248-660-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 41800 W 11 MILE RD STE 109
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City | NOVI
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State | MI
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Zip | 48375-1818
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Country | US
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Telephone | 248-660-1220
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | SVETLANA VINOKUR
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Credential |
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Telephone | 847-275-9504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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