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General NPI Number Information
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NPI Number | 1326158668
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Entity Type | Individual
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Provider Name | MICHAEL CHERKASSKY MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 603 W MAGNOLIA AVE STE 207
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City | FORT WORTH
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State | TX
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Zip | 76104-4637
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Country | US
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Telephone | 817-332-3089
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Fax | 817-338-0574
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Provider Business Mailing Address
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Address Line | 603 W MAGNOLIA AVE STE 207
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City | FORT WORTH
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State | TX
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Zip | 76104-4637
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Country | US
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Telephone | 817-332-3089
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Fax | 817-332-0574
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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 | G9078
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License Number State | TX
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