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General NPI Number Information
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NPI Number | 1669984209
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Entity Type | Organization
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Legal Business Name | BLUEGRASS ALLERGY ASTHMA AND IMMUNOLOGY PSC
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 11900 PLANTSIDE DR STE 9
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City | LOUISVILLE
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State | KY
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Zip | 40299
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Country | US
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Telephone | 502-267-0556
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Fax | 502-267-1715
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Provider Business Mailing Address
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Address Line | PO BOX 206578
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City | LOUISVILLE
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State | KY
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Zip | 40250-6578
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Country | US
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Telephone | 812-218-8926
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Fax | 812-218-8930
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. FRANK TOLIS SIMON
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Credential | MD
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Telephone | 502-386-4710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | 34409
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License Number State | KY
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