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General NPI Number Information
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NPI Number | 1861151268
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Entity Type | Organization
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Legal Business Name | LIVEWELL GASTROENTEROLOGY, PLLC
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 23 TAFT HWY STE B
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City | DRY RIDGE
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State | KY
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Zip | 41035-8121
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Country | US
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Telephone | 859-363-5515
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Fax | 859-545-5074
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Provider Business Mailing Address
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Address Line | PO BOX 739
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City | UNION
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State | KY
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Zip | 41091-0739
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Country | US
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Telephone | 859-363-5515
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Fax | 859-545-5074
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Authorized Official
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Title or Position | MANAGING MEMBER/ PRESIDENT
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Name | DR. AMY J DICHIARA
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Credential | MD
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Telephone | 859-363-5515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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