# INFECTIOUS DISEASE MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568760676
- **Authorized official:** DAVID SOUVENIR MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (208) 765-9092

## Contact information

- **Practice address:** 1875 N LAKEWOOD DR STE 101, COEUR D ALENE, ID 83814-4928
- **Practice address phone:** (208) 765-9092
- **Practice address fax:** (208) 765-9093
- **Mailing address:** PO BOX 3087, HAYDEN, ID 83835-3087
- **Mailing address phone:** (208) 765-9092
- **Mailing address fax:** (208) 765-9093

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | — | NULL | Yes |
| 207RI0200X | Infectious Disease Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/14/2011
- **Last updated:** 03/14/2011