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General NPI Number Information
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NPI Number | 1134453582
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Entity Type | Organization
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Legal Business Name | PARTNERS IN PALLIATIVE CARE PLLC
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 7504 WESTPORT RD
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City | LOUISVILLE
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State | KY
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Zip | 40222-4108
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Country | US
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Telephone | 502-693-2681
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Fax | 502-495-9738
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Provider Business Mailing Address
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Address Line | 5672 RELIABLE PARKWAY
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City | CHICAGO
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State | IL
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Zip | 60686-0056
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Country | US
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Telephone | 502-637-4579
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Fax | 502-813-3444
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. STACI A MANDROLA
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Credential | MD
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Telephone | 502-693-2681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 41139
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License Number State | KY
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