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General NPI Number Information
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NPI Number | 1174159891
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Entity Type | Organization
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Legal Business Name | RADIAL HEALTH SOUTHEAST LLC
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 11/16/2024
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Provider Practice Location Address
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Address Line | 2045 FOUNTAIN PROFESSIONAL CT STE A
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City | NAVARRE
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State | FL
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Zip | 32566-5108
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Country | US
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Telephone | 850-494-3212
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 W HIGGINS RD STE 1165
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-2050
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Country | US
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Telephone | 678-234-2992
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMISH PATEL
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Credential | DO
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Telephone | 816-728-3674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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