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General NPI Number Information
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NPI Number | 1568770089
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Entity Type | Organization
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Legal Business Name | LYNETTE SIERACKI, DO PA
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 4900 W OAKLAND PARK BLVD SUITE 203
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-7500
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Country | US
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Telephone | 954-733-5991
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Fax | 954-733-5993
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Provider Business Mailing Address
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Address Line | PO BOX 450186
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City | SUNRISE
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State | FL
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Zip | 33345-0186
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Country | US
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Telephone | 954-733-5991
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Fax | 954-733-5993
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. LYNETTE SIERACKI
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Credential | D.O.
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Telephone | 954-733-5991
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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 | ME55272
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License Number State | FL
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