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General NPI Number Information
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NPI Number | 1891859302
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Entity Type | Organization
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Legal Business Name | LOUIS LURIE, MD, INC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 480 4TH AVE SUITE 307
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City | CHULA VISTA
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State | CA
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Zip | 91910-4410
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Country | US
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Telephone | 619-426-3240
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Fax | 619-426-5964
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Provider Business Mailing Address
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Address Line | 480 4TH AVE SUITE 307
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City | CHULA VISTA
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State | CA
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Zip | 91910-4410
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Country | US
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Telephone | 619-426-3240
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Fax | 619-426-5964
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOUIS LURIE
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Credential | MD
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Telephone | 619-426-3240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G13181
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License Number State | CA
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