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General NPI Number Information
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NPI Number | 1528453123
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Entity Type | Organization
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Legal Business Name | ELITE KIDNEY CARE, LLC
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 1750 SW HEALTH PKWY STE 101
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City | NAPLES
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State | FL
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Zip | 34109-0518
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Country | US
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Telephone | 239-431-5767
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 110189
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City | NAPLES
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State | FL
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Zip | 34108-0104
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Country | US
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Telephone | 239-431-5767
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. CARLOS M MENDEZ
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Credential |
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Telephone | 239-431-5767
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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 |
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License Number State | FL
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