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General NPI Number Information
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NPI Number | 1659637551
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL CARE CENTER LLC
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 2336 SE OCEAN BLVD #215
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City | STUART
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State | FL
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Zip | 34996-3310
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Country | US
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Telephone | 561-247-9364
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Fax |
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Provider Business Mailing Address
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Address Line | 2336 SE OCEAN BLVD #215
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City | STUART
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State | FL
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Zip | 34996-3310
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Country | US
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Telephone | 561-247-9364
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SVETLANA VALEVSKI
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Credential | DOM
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Telephone | 561-247-9364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2815
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License Number State | FL
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