FM.csv

NPI,EntityTypeCode,ReplacementNPI,EmployerIdentificationNumberEIN,ProviderOrganizationNameLegalBusinessName,ProviderLastNameLegalName,ProviderFirstName,ProviderMiddleName,ProviderNamePrefixText,ProviderNameSuffixText,ProviderCredentialText,ProviderOtherOrganizationName,ProviderOtherOrganizationNameTypeCode,ProviderOtherLastName,ProviderOtherFirstName,ProviderOtherMiddleName,ProviderOtherNamePrefixText,ProviderOtherNameSuffixText,ProviderOtherCredentialText,ProviderOtherLastNameTypeCode,ProviderFirstLineBusinessMailingAddress,ProviderSecondLineBusinessMailingAddress,ProviderBusinessMailingAddressCityName,ProviderBusinessMailingAddressStateName,ProviderBusinessMailingAddressPostalCode,ProviderBusinessMailingAddressCountryCodeIfoutsideUS,ProviderBusinessMailingAddressTelephoneNumber,ProviderBusinessMailingAddressFaxNumber,ProviderFirstLineBusinessPracticeLocationAddress,ProviderSecondLineBusinessPracticeLocationAddress,ProviderBusinessPracticeLocationAddressCityName,ProviderBusinessPracticeLocationAddressStateName,ProviderBusinessPracticeLocationAddressPostalCode,ProviderBusinessPracticeLocationAddressCountryCodeIfoutsideUS,ProviderBusinessPracticeLocationAddressTelephoneNumber,ProviderBusinessPracticeLocationAddressFaxNumber,ProviderEnumerationDate,LastUpdateDate,NPIDeactivationReasonCode,NPIDeactivationDate,NPIReactivationDate,ProviderGenderCode,AuthorizedOfficialLastName,AuthorizedOfficialFirstName,AuthorizedOfficialMiddleName,AuthorizedOfficialTitleorPosition,AuthorizedOfficialTelephoneNumber,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch,HealthcareProviderTaxonomyCode,ProviderLicenseNumber,ProviderLicenseNumberStateCode,HealthcareProviderPrimaryTaxonomySwitch
1962438952,2,,<UNAVAIL>,L. CREAGH CORP.,,,,,,,,,,,,,,,,3600 S. STATE RD.,SUITE 230,MIRAMAR,FM,33023,US,9549875758,9549875752,3600 S. STATE RD.,SUITE 230,MIRAMAR,FM,33023,US,9549875758,9549875752,06/23/2006,08/22/2020,,,,,CREAGH,LAZARO,,PRESIDENT,9549875758,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,,332B00000X,,,
1306854278,1,,,,LAWRENCE,SHARON,HELENE,DR.,,DMD,,,,,,,,,,403 M SWINTON AVE,,DELRAY BEACH,FM,334443953,US,5612721686,5612799700,403 M SWINTON AVE,,DELRAY BEACH,FL,334443953,US,5612721686,5612799700,08/04/2006,07/08/2007,,,,F,,,,,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,,122300000X,DN12012,FL,
1336235878,1,,,,DAVIS,CHANELL,LENETTE,MS.,,SWT,,,,,,,,,,2051 W GRAND BLVD,,DETROIT,FM,482081105,US,3139613700,3139613769,2051 W GRAND BLVD,,DETROIT,FM,482081105,US,3139613700,3139613769,10/04/2006,07/08/2007,,,,F,,,,,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,,104100000X,6803082782,MI,
1184707002,1,,,,ROBINER,WILLIAM,N,,,PHD,,,,,,,,,,420 DELAWARE STREET SE,UNIVERSITY OF MINNESOTA PHYSICIANS,MINNEAPOLIS,FM,55455,US,6128840999,,516 DELAWARE ST SE,"PWB THIRD FLOOR, CLINIC 3A",MINNEAPOLIS,MN,554550356,US,6128840999,,10/23/2006,07/08/2007,,,,M,,,,,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,,103TH0100X,LP0379,MN,
1801966767,1,,,,MANCEWICZ,GARY,W.,DR.,,D.D.S.,,,,,,,,,,2351 COUNTRYWOOD DR. SE,SUITE B,KENTWOOD,FM,49508,US,6164553020,6164551397,2351 COUNTRYWOOD DR SE,SUITE B,GRAND RAPIDS,MI,495085065,US,6164553020,6164551397,11/08/2006,07/08/2007,,,,M,,,,,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,,122300000X,29-01-011327,MI,
1245368257,1,,,,TATO,XAVIER,JAMAL,DR.,,PHARMD,,,,,,,,,,1930 W STADIUM BLVD,,ANN ARBOR,FM,48103,US,7349134752,7349139032,1930 W STADIUM BLVD,,ANN ARBOR,FM,48103,US,7349134752,7349139032,03/01/2007,07/08/2007,,,,M,,,,,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,,183500000X,5301007692,MI,
1326170135,1,,,,LOVETT,PAULA,S,MS.,,PHD,,,,,,,,,,PO BOX 90308,,GAINESVILLE,FM,32607,US,3523782600,3523781828,5024 NW 27TH COURT,SUITE B,GAINESVILLE,FL,32606,US,3523782600,3523781828,03/09/2007,07/08/2007,,,,F,,,,,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,,101YM0800X,MH001143,FL,
1437376050,2,,<UNAVAIL>,PARADISE MEDICAL CLINIC INC,,,,,,,,,,,,,,,,911 SW 87TH AVENUE,,MIAMI,FM,33174,US,3052643307,3052643370,911 SW 87TH AVE,,MIAMI,FL,331743206,US,3052643307,3052643370,04/18/2007,07/21/2022,,,,,REYTOR,FRANCISCO,A,PRESIDENT,3052643307,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,,261Q00000X,,FL,
1730388075,1,,,,HOUSTON,GINA,MARIE,MS.,,,,,,,,,,,,500 MEADOW SWEET CIRCLE,,OSPREY,FM,342298975,US,9419665090,,8254 118TH AVE N,LAMPERTS HOME THERAPY INC SUITE 100,LARGO,FL,33773,US,7275415304,,07/17/2007,07/17/2007,,,,F,,,,,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,,235Z00000X,SA5665,FL,
1538333760,2,,<UNAVAIL>,WELLNESS CLINIC INC,,,,,,,,,,,,,,,,7191 TAFT ST,,HOLLYWOOD,FM,33024,US,9542746000,9547273024,7191 TAFT ST,,HOLLYWOOD,FL,33024,US,9542746000,9547273024,04/18/2008,04/18/2008,,,,,BOTTON,ELIEZER,,OWNER,9542746000,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,,171100000X,AP2225,FL,
1801257399,1,,,,ALLISON,CHERYL,,,,NMT,,,,,,,,,,4597 HOLLISTON ROAD,,ATLANTA,FM,30360,US,,,6495 SHILOH RD,,ALPHARETTA,GA,30005,US,7707409200,,03/11/2016,03/11/2016,,,,F,,,,,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,,225700000X,MT003483,GA,