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General NPI Number Information
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NPI Number | 1568689875
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Entity Type | Organization
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Legal Business Name | CLOVERLEAF FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1064 E MAIN ST
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City | MERIDEN
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State | CT
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Zip | 06450-4898
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Country | US
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Telephone | 203-634-3636
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Fax | 203-634-1972
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Provider Business Mailing Address
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Address Line | 1064 E MAIN ST
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City | MERIDEN
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State | CT
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Zip | 06450-4898
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Country | US
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Telephone | 203-634-3636
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Fax | 203-634-1972
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Authorized Official
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Title or Position | BILLING REPRESENTATIVE
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Name | MS. SHERYL TURLIS
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Credential |
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Telephone | 203-269-4376
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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 | 027029
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License Number State | CT
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