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General NPI Number Information
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NPI Number | 1154415404
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Entity Type | Individual
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Provider Name | MICHAEL A. IMON AA-C
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 2201 45TH STREET
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City | WEST PALM BEACH
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State | FL
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Zip | 33407
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Country | US
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Telephone | 954-838-2371
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Fax | 954-851-1758
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Provider Business Mailing Address
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Address Line | 1613 N HARRISON PARKWAY #200
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City | SUNRISE
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State | FL
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Zip | 33323-2853
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Country | US
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Telephone | 954-838-2371
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Fax | 954-851-1746
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 001965
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | AA85
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License Number State | FL
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