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General NPI Number Information
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NPI Number | 1558640938
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Entity Type | Organization
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Legal Business Name | SOUTH DALLAS INFUSION CENTER, PA
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 2727 BOLTON BOONE DR STE 109A
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City | DESOTO
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State | TX
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Zip | 75115-2019
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Country | US
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Telephone | 972-283-2370
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Fax | 972-588-1041
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Provider Business Mailing Address
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Address Line | PO BOX 678057
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City | DALLAS
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State | TX
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Zip | 75267-8057
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Country | US
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Telephone | 972-283-2370
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Fax | 972-588-1041
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHESH B KOTTAPALLI
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Credential | MD
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Telephone | 972-283-2370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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