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General NPI Number Information
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NPI Number | 1952598187
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Entity Type | Organization
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Legal Business Name | BENNETT L. WOLANSKY, DPM, PA
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 10/02/2007
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Provider Practice Location Address
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Address Line | 4601 S UNIVERSITY DR
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City | DAVIE
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State | FL
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Zip | 33328-3817
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Country | US
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Telephone | 954-680-7133
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Fax | 954-680-7135
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Provider Business Mailing Address
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Address Line | 4601 S UNIVERSITY DR
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City | DAVIE
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State | FL
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Zip | 33328-3817
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Country | US
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Telephone | 954-680-7133
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Fax | 954-680-7135
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENNETT L WOLANSKY
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Credential | DPM
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Telephone | 954-680-7133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO 2066
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License Number State | FL
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