Provider Demographics
NPI:1497914949
Name:PRAKASAM, SOUMIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOUMIYA
Middle Name:
Last Name:PRAKASAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S MORGAN STREET
Mailing Address - Street 2:UNIT 401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2726
Mailing Address - Country:US
Mailing Address - Phone:312-371-9381
Mailing Address - Fax:
Practice Address - Street 1:111 S MORGAN ST
Practice Address - Street 2:UNIT 401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2724
Practice Address - Country:US
Practice Address - Phone:312-371-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125 050901207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine