Healthcare Provider Details

I. General information

NPI: 1649593161
Provider Name (Legal Business Name): CARDIOVASCULAR IMAGING CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVE S SUITE 125
EDINA MN
55435-2131
US

IV. Provider business mailing address

7801 E BUSH LAKE RD SUITE 320
MINNEAPOLIS MN
55439-3120
US

V. Phone/Fax

Practice location:
  • Phone: 952-929-5600
  • Fax: 952-929-5610
Mailing address:
  • Phone: 952-831-5773
  • Fax: 952-831-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1510
License Number StateMN

VIII. Authorized Official

Name: ELIZABETH KLODAS
Title or Position: PRESIDENT/PHYSICIAN
Credential: MD
Phone: 952-929-5600