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General NPI Number Information
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NPI Number | 1164474318
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Entity Type | Organization
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Legal Business Name | NIKORB MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3900 KRESGE WAY
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City | LOUISVILLE
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State | KY
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Zip | 40207-4660
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Country | US
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Telephone | 502-894-4418
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Fax | 502-894-8966
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Provider Business Mailing Address
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Address Line | 3900 KRESGE WAY
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City | LOUISVILLE
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State | KY
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Zip | 40207-4681
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Country | US
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Telephone | 502-894-4418
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Fax | 502-894-8966
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THEADORE MICHAEL IVANCHAK
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Credential |
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Telephone | 502-849-4418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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