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General NPI Number Information
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NPI Number | 1366438707
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 511 S. FLOYD STREET ROOM 203
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City | LOUISVILLE
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State | KY
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Zip | 40292-0001
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Country | US
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Telephone | 502-852-5519
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Fax | 502-852-1171
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Provider Business Mailing Address
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Address Line | PO BOX 3311
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City | LOUISVILLE
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State | KY
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Zip | 40201-3311
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Country | US
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Telephone | 502-852-1174
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Fax | 502-852-2046
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MOSTAFA FRAIG
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Credential | M.D.
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Telephone | 502-852-1174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 200123
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License Number State | KY
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