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General NPI Number Information
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NPI Number | 1184892739
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Entity Type | Organization
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Legal Business Name | OUR HEART AND VASCULAR CENTER LLC
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 13740 OFFICE PARK CT
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City | HUDSON
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State | FL
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Zip | 34667-7145
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Country | US
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Telephone | 727-869-5100
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Fax | 727-869-5166
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Provider Business Mailing Address
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Address Line | 13740 OFFICE PARK CT
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City | HUDSON
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State | FL
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Zip | 34667-7145
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Country | US
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Telephone | 727-869-5100
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Fax | 727-869-5166
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GOPAL KISHORE CHALAVARYA
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Credential | M.D
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Telephone | 727-869-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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