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General NPI Number Information
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NPI Number | 1851510846
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Entity Type | Organization
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Legal Business Name | PROSPERO ISHKANIAN MD PSC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 1313 SAINT ANTHONY PL
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City | LOUISVILLE
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State | KY
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Zip | 40204-1740
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Country | US
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Telephone | 502-560-1326
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Fax | 502-560-1327
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Provider Business Mailing Address
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Address Line | 7101 WESBORO RD
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City | LOUISVILLE
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State | KY
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Zip | 40222-6453
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Country | US
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Telephone | 502-560-1326
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Fax | 502-560-1327
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. PROSPERO ISHKANIAN
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Credential | MD
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Telephone | 502-560-1326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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