Organization
WYOMING VEIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAIRAV SHAH MD (OWNER)
(307) 570-5867
Entity
Organization
Contact information
Practice address
4112 LARAMIE ST, CHEYENNE, WY 82001-1969
(307) 670-5867
Mailing address
4112 LARAMIE ST, CHEYENNE, WY 82001-1969
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
Primary
9196A
WY
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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