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General NPI Number Information
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NPI Number | 1467728857
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Entity Type | Organization
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Legal Business Name | LAKSHMI BUSHAN MD PA
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 4755 SUMMERLIN RD SUITE 8
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City | FORT MYERS
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State | FL
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Zip | 33919-1073
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Country | US
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Telephone | 239-275-5339
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Fax | 239-275-5595
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Provider Business Mailing Address
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Address Line | 4755 SUMMERLIN RD SUITE 8
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City | FORT MYERS
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State | FL
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Zip | 33919-1073
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Country | US
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Telephone | 239-275-5339
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Fax | 239-275-5595
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAKSHMI BUSHAN
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Credential | M.D.
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Telephone | 239-275-5339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME57213
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License Number State | FL
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