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General NPI Number Information
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NPI Number | 1821429523
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Entity Type | Organization
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Legal Business Name | MED-MANAGE GROUP, INC
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 2100 LAKE IDA RD STE 1
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2442
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Country | US
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Telephone | 561-265-1116
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Fax | 561-265-1296
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Provider Business Mailing Address
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Address Line | 2100 LAKE IDA RD STE 1
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2442
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Country | US
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Telephone | 561-265-1116
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Fax | 561-265-1296
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN BOTTARI
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Credential | PH.D
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Telephone | 561-265-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME92179
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME55094
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License Number State | FL
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