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General NPI Number Information
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NPI Number | 1407039860
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Entity Type | Individual
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Provider Name | VIJAYASEKHARA REDDY KALAKATA MD
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Gender | Male
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 690 NE 3RD AVE STE 104
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-3541
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Country | US
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Telephone | 352-365-0045
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Fax | 353-364-0047
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Provider Business Mailing Address
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Address Line | 208 S HARRISON ST
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-4061
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Country | US
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Telephone | 352-365-0045
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Fax | 353-364-0047
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 045574
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME101929
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License Number State | FL
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