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General NPI Number Information
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NPI Number | 1457809253
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Entity Type | Organization
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Legal Business Name | THE PHYSICIANS GROUP PRACTICE LLC
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 3915 BISCAYNE BLVD SUITE 301
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City | MIAMI
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State | FL
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Zip | 33137-3779
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Country | US
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Telephone | 954-579-3916
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Fax | 954-239-3902
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Provider Business Mailing Address
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Address Line | 3915 BISCAYNE BLVD SUITE 301
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City | MIAMI
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State | FL
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Zip | 33137-3779
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Country | US
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Telephone | 954-579-3916
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Fax | 954-239-3902
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | AMOL MALANKAR
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Credential | MD
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Telephone | 954-579-3916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS12758
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License Number State | FL
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