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General NPI Number Information
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NPI Number | 1588359293
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Entity Type | Organization
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Legal Business Name | COMPLETE DERMATOLOGY LLC
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 21550 BISCAYNE BLVD STE 131
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City | AVENTURA
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State | FL
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Zip | 33180-1258
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Country | US
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Telephone | 305-814-3376
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Fax | 305-939-5928
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Provider Business Mailing Address
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Address Line | 21550 BISCAYNE BLVD STE 131
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City | AVENTURA
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State | FL
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Zip | 33180-1258
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Country | US
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Telephone | 305-814-3376
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Fax | 305-939-5928
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Authorized Official
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Title or Position | PROVIDER
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Name | DAN ILKOVITCH
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Credential | MD
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Telephone | 240-354-6931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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