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General NPI Number Information
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NPI Number | 1265865471
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Entity Type | Organization
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Legal Business Name | JEFFREY WISNICKI, M.D., P.A.
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 13005 SOUTHERN BLVD SUITE 133
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9206
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Country | US
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Telephone | 561-798-1400
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Fax | 561-798-0255
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Provider Business Mailing Address
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Address Line | 13005 SOUTHERN BLVD SUITE 133
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9206
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Country | US
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Telephone | 561-798-1400
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Fax | 561-798-0255
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY WISNICKI
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Credential | M.D.
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Telephone | 561-798-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | ME 48094
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License Number State | FL
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