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General NPI Number Information
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NPI Number | 1336965342
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Entity Type | Organization
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Legal Business Name | ST JUDE MEDICAL GROUP CORP
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 10522 SW 8TH ST
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City | MIAMI
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State | FL
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Zip | 33174-2602
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Country | US
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Telephone | 786-464-5120
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Fax | 786-464-5125
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Provider Business Mailing Address
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Address Line | 2141 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33125-3483
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Country | US
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Telephone | 786-464-5120
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Fax | 786-464-5125
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MANUEL D. GONZALEZ
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Credential | MD
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Telephone | 786-464-5120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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