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General NPI Number Information
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NPI Number | 1245249226
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Entity Type | Organization
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Legal Business Name | CAPITOL UROLOGY MEDICAL GROUP INC
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 500 UNIVERSITY AVE SUITE 200
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City | SACRAMENTO
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State | CA
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Zip | 95825-6504
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Country | US
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Telephone | 916-921-4530
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Fax | 916-924-1611
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Provider Business Mailing Address
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Address Line | 500 UNIVERSITY AVE SUITE 200
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City | SACRAMENTO
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State | CA
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Zip | 95825-6504
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Country | US
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Telephone | 916-921-4530
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Fax | 916-924-1611
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KIUMARS R HEKMAT
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Credential | M.D.
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Telephone | 916-921-4529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A37811
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License Number State |
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