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General NPI Number Information
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NPI Number | 1295748176
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Entity Type | Individual
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Provider Name | MICHAEL DIAZ MD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 1513 S HARBOR CITY BLVD
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City | MELBOURNE
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State | FL
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Zip | 32901
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Country | US
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Telephone | 321-951-2639
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Fax | 321-914-0938
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Provider Business Mailing Address
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Address Line | 1513 S HARBOR CITY BLVD
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City | MELBOURNE
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State | FL
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Zip | 32901-4681
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Country | US
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Telephone | 321-951-2639
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Fax | 321-914-0938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ME74679
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License Number State | FL
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