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General NPI Number Information
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NPI Number | 1801722178
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Entity Type | Organization
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Legal Business Name | OBSIDIAN HEALTH MANAGEMENT SERVICES LLC
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Dates
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Enumeration Date | 06/23/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 2350 CYPRESS POND RD APT 1613
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City | PALM HARBOR
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State | FL
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Zip | 34683-1507
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Country | US
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Telephone | 813-609-0552
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 CYPRESS POND RD APT 1613
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City | PALM HARBOR
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State | FL
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Zip | 34683-1507
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Country | US
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Telephone | 813-609-0552
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | RAJIV MICHAEL DAVID HUDEK
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Credential |
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Telephone | 629-326-0415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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