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General NPI Number Information
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NPI Number | 1770926404
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Entity Type | Individual
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Provider Name | MICHAIL MAVROS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 4301 W MARKHAM ST # 783
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-686-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE FL 2
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-2704
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D0101220
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E-13630
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License Number State | AR
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