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General NPI Number Information
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NPI Number | 1205278454
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Entity Type | Organization
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Legal Business Name | MEDICAL & PSYCHIATRIC INSITIUTE OF FLORIDA, INC.
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 6056 CENTRAL PARK BLVD
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City | PORT ORANGE
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State | FL
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Zip | 32127-9539
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Country | US
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Telephone | 304-216-4000
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Fax | 386-676-2555
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Provider Business Mailing Address
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Address Line | 927 BEVILLE RD STE 7
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City | SOUTH DAYTONA
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State | FL
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Zip | 32119-1769
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Country | US
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Telephone | 386-269-9009
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Fax | 386-269-9004
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Authorized Official
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Title or Position | OWNER
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Name | ASAD KHAN
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Credential | MD
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Telephone | 304-216-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | ME114528
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License Number State | FL
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