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General NPI Number Information
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NPI Number | 1417188921
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR INSTITUTE PC
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 750 N SYRINGA ST
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City | POST FALLS
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State | ID
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Zip | 83854-5275
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Country | US
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Telephone | 866-248-4485
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3482
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City | POST FALLS
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State | ID
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Zip | 83877-3482
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Country | US
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Telephone | 208-618-0690
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROMEO ANTON PAVLIC
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Credential | MD
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Telephone | 208-777-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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