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General NPI Number Information
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NPI Number | 1114783859
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Entity Type | Organization
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Legal Business Name | KIDNEY AND HYPERTENSION CARE MID-AMERICA LLC
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Dates
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Enumeration Date | 02/21/2024
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 400 MAPLE SUMMIT RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2028
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Country | US
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Telephone | 314-628-7750
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 289
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City | CHESTERFIELD
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State | MO
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Zip | 63006-0289
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Country | US
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Telephone | 314-628-7750
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MEHER S MALLICK
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Credential | MD
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Telephone | 314-628-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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