| Infectious Disease Medicine Llc | |
|
1875 N Lakewood Dr Ste 101 Coeur D Alene ID 83814-4928 | |
| (208) 765-9092 | |
| (208) 765-9093 |
| Full Name | Infectious Disease Medicine Llc |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 1875 N Lakewood Dr Ste 101, Coeur D Alene, Idaho |
| Authorized Official Name and Position | David Souvenir (OWNER/PHYSICIAN) |
| Authorized Official Contact | 2087659092 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Disease Medicine Llc Po Box 3087 Hayden ID 83835-3087 Ph: (208) 765-9092 | Infectious Disease Medicine Llc 1875 N Lakewood Dr Ste 101 Coeur D Alene ID 83814-4928 Ph: (208) 765-9092 |
| NPI Number | 1568760676 |
|---|---|
| Provider Enumeration Date | 03/14/2011 |
| Last Update Date | 03/14/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568760676 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
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