1649593161 NPI number — CARDIOVASCULAR IMAGING CONSULTANTS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649593161 NPI number — CARDIOVASCULAR IMAGING CONSULTANTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR IMAGING CONSULTANTS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649593161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7801 E BUSH LAKE RD
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55439-3120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-831-5773
Provider Business Mailing Address Fax Number:
952-831-7224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6545 FRANCE AVE S
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-929-5600
Provider Business Practice Location Address Fax Number:
952-929-5610
Provider Enumeration Date:
03/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KLODAS
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
952-929-5600

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  1510 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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