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General NPI Number Information
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NPI Number | 1841492030
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Entity Type | Individual
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Provider Name | SUDHA DIVAKAR LOLAYEKAR MD
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Gender | Female
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 5555 PONCE DE LEON BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33146-2513
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Country | US
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Telephone | 305-284-5054
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 NW 12TH AVE JMT-EAST 1007
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City | MIAMI
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State | FL
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Zip | 33136-1028
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Country | US
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Telephone | 305-243-4664
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Fax | 305-243-9927
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0097573
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License Number State | FL
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