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General NPI Number Information
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NPI Number | 1154593945
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Entity Type | Individual
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Provider Name | MOHAMAD ISTANBOLI MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 150 N EAGLE CREEK DR
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City | LEXINGTON
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State | KY
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Zip | 40509-1805
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Country | US
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Telephone | 859-967-5000
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Fax | 606-330-3100
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Provider Business Mailing Address
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Address Line | PO BOX 73652
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City | CLEVELAND
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State | OH
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Zip | 44193-0002
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Country | US
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Telephone | 606-330-3404
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Fax | 606-330-3100
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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 | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 41634
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License Number State | KY
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