Provider Demographics
NPI:1497915367
Name:PAUL G SOMMER DPM PC
Entity Type:Organization
Organization Name:PAUL G SOMMER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-477-3668
Mailing Address - Street 1:1610 POINTE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7098
Mailing Address - Country:US
Mailing Address - Phone:219-477-3668
Mailing Address - Fax:219-531-1520
Practice Address - Street 1:1610 POINTE DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7098
Practice Address - Country:US
Practice Address - Phone:219-477-3668
Practice Address - Fax:219-531-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000690A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200901950 AMedicaid
IN656050Medicare PIN
IN200901950 AMedicaid