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General NPI Number Information
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NPI Number | 1356992846
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Entity Type | Organization
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Legal Business Name | JOSE R PRIETO MD PA
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 214 MORRISON RD STE 104
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City | BRANDON
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State | FL
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Zip | 33511-4849
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Country | US
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Telephone | 813-681-6474
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Fax | 813-654-8473
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Provider Business Mailing Address
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Address Line | 901 MCCLINTOCK DR STE 202
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City | BURR RIDGE
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State | IL
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Zip | 60527-0872
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Country | US
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Telephone | 630-655-7290
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Fax | 630-734-4685
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Authorized Official
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Title or Position | HR
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Name | TARA KOWALSKI
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Credential |
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Telephone | 630-655-7290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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