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General NPI Number Information
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NPI Number | 1710155296
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Entity Type | Organization
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Legal Business Name | UNITED PULMONARY & SLEEP MEDICINE, INC
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 1828 E FLORENCE BLVD SUITE 112
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City | CASA GRANDE
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State | AZ
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Zip | 85222-4783
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Country | US
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Telephone | 520-374-8915
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Fax |
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Provider Business Mailing Address
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Address Line | 1686 E DIEGO DR
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City | CASA GRANDE
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State | AZ
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Zip | 85222-6340
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Country | US
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Telephone | 520-836-1161
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RAJEESH PUNNAKKATTU
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Credential | MD
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Telephone | 520-836-1161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 31787
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 31787
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 31787
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License Number State | AZ
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