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General NPI Number Information
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NPI Number | 1871020842
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Entity Type | Organization
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Legal Business Name | MOHIB MEDICAL LLC
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 410 LIONEL WAY STE 200
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City | DAVENPORT
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State | FL
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Zip | 33837-7809
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Country | US
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Telephone | 863-353-2602
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Fax |
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Provider Business Mailing Address
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Address Line | 410 LIONEL WAY STE 200
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City | DAVENPORT
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State | FL
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Zip | 33837-7809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MARK NICOLE
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Credential |
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Telephone | 321-223-4470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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