Organization
INFECTIOUS DISEASE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID SOUVENIR MD (OWNER/PHYSICIAN)
(208) 765-9092
Entity
Organization
Contact information
Practice address
1875 N LAKEWOOD DR STE 101, COEUR D ALENE, ID 83814-4928
(208) 765-9092
(208) 765-9093
Mailing address
PO BOX 3087, HAYDEN, ID 83835-3087
(208) 765-9092
(208) 765-9093
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Enumeration date
03/14/2011
Last updated
03/14/2011
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