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General NPI Number Information
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NPI Number | 1457508343
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Entity Type | Organization
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Legal Business Name | VINAYAK V PURANDARE MD PL
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 401 LAKEBRIDGE PLAZA DR
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5157
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Country | US
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Telephone | 386-672-8595
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Fax | 386-677-4987
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Provider Business Mailing Address
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Address Line | 305 MEMORIAL MEDICAL PARKWAY, SUITE 507
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City | DAYTONA BEACH
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State | FL
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Zip | 32117
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Country | US
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Telephone | 386-672-8595
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Fax | 386-677-4987
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Authorized Official
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Title or Position | OWNER
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Name | VINAYAK V PURANDARE
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Credential | M.D.
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Telephone | 386-672-8595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME0045136
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License Number State | FL
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