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General NPI Number Information
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NPI Number | 1154712198
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Entity Type | Organization
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Legal Business Name | PEDIATRIC &ADOLESCENT MEDICINE
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 7150 W 20TH AVE STE 612
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City | HIALEAH
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State | FL
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Zip | 33016-5534
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Country | US
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Telephone | 305-827-1561
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Fax |
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Provider Business Mailing Address
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Address Line | 7150 W 20TH AVE STE 612
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City | HIALEAH
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State | FL
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Zip | 33016-5534
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Country | US
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Telephone | 305-827-1561
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ROBERT BELLAMINE O'NEILL
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Credential | M.D.
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Telephone | 305-827-1561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | ME0063187
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License Number State | FL
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