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General NPI Number Information
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NPI Number | 1518081595
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Entity Type | Individual
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Provider Name | VICTOR MIROSHNICHENKO DPM
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 8333 W MCNAB RD SUITE 116
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City | TAMARAC
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State | FL
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Zip | 33321-3242
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Country | US
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Telephone | 954-721-1990
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Fax | 954-721-1932
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Provider Business Mailing Address
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Address Line | 8333 W MCNAB RD SUITE 116
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City | TAMARAC
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State | FL
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Zip | 33321-3242
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Country | US
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Telephone | 954-721-1990
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Fax | 954-721-1932
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | PO 2442
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License Number State | FL
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