MEDICARE: C EDWARD VAURIO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	018720	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	XX1920197002	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1477662609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	C EDWARD VAURIO M.D.

Provider Business Mailing Address
First Line	:	825 S 8TH ST STE 600
Second Line	:	PARKSIDE PROFESSIONAL BLDG
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1209
Country	:	US
Telephone Number	:	612-339-7171
Fax Number	:	612-339-2885

Provider Business Practice Location Address
First Line	:	825 S 8TH ST STE 600
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1209
Country	:	US
Telephone Number	:	612-339-7171
Fax Number	:	612-339-2885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/14/2008

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