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General NPI Number Information
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NPI Number | 1760736912
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Entity Type | Individual
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Provider Name | KENDALL CORY MARHALIK PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 1900 DON WICKHAM DR
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City | CLERMONT
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State | FL
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Zip | 34711-1979
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Country | US
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Telephone | 352-241-7180
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Fax | 352-241-7184
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Provider Business Mailing Address
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Address Line | 913 EASLEY AVE
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5387
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Country | US
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Telephone | 407-497-9485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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