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NPI 1700995198

NPI 1700995198 : ORTHO DESIGN INC : PLANTATION, FL

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General NPI Number Information
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    NPI Number           |    1700995198
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    Entity Type          |    Organization 
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    Legal Business Name  |    ORTHO DESIGN INC 
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Dates
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    Enumeration Date     |    08/30/2006
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    Last Update Date     |    08/24/2009
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Provider Practice Location Address
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    Address Line         |    447 NW 73RD AVE 
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    City                 |    PLANTATION
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    State                |    FL
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    Zip                  |    33317-1608
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    Country              |    US
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    Telephone            |    954-797-0181
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    Fax                  |    954-797-0332
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Provider Business Mailing Address
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    Address Line         |    447 NW 73RD AVE 
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    City                 |    PLANTATION
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    State                |    FL
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    Zip                  |    33317-1608
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    Country              |    US
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    Telephone            |    954-797-0181
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    Fax                  |    954-797-0332
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |    MR. PETER MICHAEL BUKACHESKI 
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    Credential           |    
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    Telephone            |    954-797-0181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    332B00000X
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    Taxonomy Name        |    Durable Medical Equipment & Medical Supplies
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    License Number       |    ORT11
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    License Number State |    FL
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