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General NPI Number Information
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NPI Number | 1922155357
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Entity Type | Individual
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Provider Name | THAMOTHARAMPILLAI SIVARAJ MD
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 975 BAPTIST WAY
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City | HOMESTEAD
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State | FL
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Zip | 33033-7600
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Country | US
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Telephone | 786-243-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 8912 NW 161ST TER
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City | MIAMI LAKES
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State | FL
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Zip | 33018-1426
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Country | US
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Telephone | 919-622-4294
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Fax | 919-622-4294
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9901648
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 9901648
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License Number State | NC
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