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General NPI Number Information
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NPI Number | 1457650145
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Entity Type | Organization
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Legal Business Name | CKW GROUP, ADVANCED VENOUS THERAPY
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 1631 LANCASTER DR SUITE240
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City | GRAPEVINE
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State | TX
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Zip | 76051-3585
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Country | US
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Telephone | 817-510-5000
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Fax | 817-442-9586
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Provider Business Mailing Address
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Address Line | 1631 LANCASTER DR SUITE240
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City | GRAPEVINE
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State | TX
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Zip | 76051-3585
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Country | US
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Telephone | 817-510-5000
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Fax | 817-442-9586
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID E KOSMOSKI
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Credential | MD
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Telephone | 817-510-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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