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General NPI Number Information
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NPI Number | 1215253802
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Entity Type | Organization
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Legal Business Name | LAKE ANESTHESIA CARE LLC
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 2130 VINDALE RD
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City | TAVARES
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State | FL
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Zip | 32778-5637
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Country | US
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Telephone | 353-383-7777
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Fax | 352-383-8875
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Provider Business Mailing Address
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Address Line | 2060 N DONNELLY ST
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City | MOUNT DORA
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State | FL
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Zip | 32757-2824
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Country | US
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Telephone | 352-383-7777
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Fax | 352-383-8875
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LALBAHADUR S NAGABHAIRU
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Credential | M.D.
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Telephone | 352-636-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME63590
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License Number State | FL
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