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General NPI Number Information
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NPI Number | 1831397579
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Entity Type | Organization
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Legal Business Name | CORPORATE HEALTH CARE PSC
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8013 NEW LAGRANGE RD SUITE #5
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City | LOUISVILLE
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State | KY
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Zip | 40222-4700
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Country | US
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Telephone | 502-425-9930
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Fax | 502-425-0915
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Provider Business Mailing Address
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Address Line | 8013 NEW LAGRANGE RD SUITE #5
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City | LOUISVILLE
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State | KY
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Zip | 40222-4700
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Country | US
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Telephone | 502-425-9930
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Fax | 502-425-0915
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACOB BLUM
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Credential | MD
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Telephone | 502-425-9930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 28306
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License Number State | KY
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