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General NPI Number Information
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NPI Number | 1639559750
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Entity Type | Organization
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Legal Business Name | VIVIAN BILASANO MD LLC
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 1951 SW 172ND AVE SUITE312
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City | MIRAMAR
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State | FL
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Zip | 33029-5593
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Country | US
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Telephone | 954-320-7999
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Fax | 954-320-7601
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Provider Business Mailing Address
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Address Line | 1951 SW 172ND AVE SUITE312
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City | MIRAMAR
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State | FL
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Zip | 33029-5593
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Country | US
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Telephone | 954-320-7999
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Fax | 954-320-7601
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Authorized Official
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Title or Position | MANAGER
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Name | DR. VIVIAN BILASANO
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Credential | MD
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Telephone | 954-320-7999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME 77619
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License Number State | FL
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