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General NPI Number Information
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NPI Number | 1912303538
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Entity Type | Organization
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Legal Business Name | A&M MEDICAL VENTURES, INC
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 2850 E SKYLINE DR SUITE 130
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City | TUCSON
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State | AZ
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Zip | 85718-8012
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Country | US
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Telephone | 202-621-3641
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Fax |
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Provider Business Mailing Address
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Address Line | 2850 E SKYLINE DR SUITE 130
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City | TUCSON
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State | AZ
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Zip | 85718-8012
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Country | US
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Telephone | 202-621-3641
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATEJA DELEONNI STANONIK
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Credential | MD
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Telephone | 202-621-3641
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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 | 47675
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License Number State | AZ
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