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General NPI Number Information
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NPI Number | 1962804567
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Entity Type | Organization
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Legal Business Name | GRAHAM M CORMACK, MD, LLC
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 1301 PUNCHBOWL ST
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City | HONOLULU
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State | HI
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Zip | 96813
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Country | US
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Telephone | 808-343-2769
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Fax | 866-594-4786
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Provider Business Mailing Address
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Address Line | PO BOX 26418
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City | HONOLULU
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State | HI
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Zip | 96825
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Country | US
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Telephone | 808-343-2769
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Fax | 866-594-4786
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GRAHAM MICHAEL CORMACK
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Credential | MD
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Telephone | 808-343-2769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD13938
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License Number State | HI
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