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General NPI Number Information
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NPI Number | 1588480388
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN AND REGENERATIVE CLINIC LLC
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 12989 SOUTHERN BLVD STE 205
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9291
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Country | US
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Telephone | 501-282-0953
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Fax |
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Provider Business Mailing Address
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Address Line | 12989 SOUTHERN BLVD STE 205
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9291
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Country | US
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Telephone | 212-463-0911
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. ANDY DHILLON
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Credential |
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Telephone | 212-463-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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