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General NPI Number Information
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NPI Number | 1265017446
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Entity Type | Organization
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Legal Business Name | VASCULAR CENTER OF THE MIDWEST (VCM), LLC
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 3085 WOODMAN DR STE 320
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City | DAYTON
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State | OH
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Zip | 45420-1171
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Country | US
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Telephone | 937-795-1090
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Fax | 937-795-1145
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Provider Business Mailing Address
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Address Line | 78 PARK RD
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City | OAKWOOD
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State | OH
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Zip | 45419-3001
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Country | US
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Telephone | 858-829-4072
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHANKAR M SUNDARAM
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Credential |
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Telephone | 858-829-4072
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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 |
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License Number State |
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