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General NPI Number Information
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NPI Number | 1154427854
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Entity Type | Organization
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Legal Business Name | BLANCHARD VALLEY VASCULAR SURGERY ASSOCIATES LLC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 1900 S MAIN ST CDS SUITE 349
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City | FINDLAY
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State | OH
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Zip | 45840-1214
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Country | US
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Telephone | 419-420-9175
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Fax | 419-420-3674
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Provider Business Mailing Address
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Address Line | PO BOX 450637
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City | WESTLAKE
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State | OH
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Zip | 44145-0611
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Country | US
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Telephone | 800-514-4390
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Fax | 440-808-3675
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL D MALONE
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Credential | MD
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Telephone | 419-420-9175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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