Provider Demographics
NPI:1619176328
Name:SALOUM, AMBER RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:RAY
Last Name:SALOUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:SOMMERVOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:
Practice Address - Street 1:1417 S CLIFF AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1064
Practice Address - Country:US
Practice Address - Phone:605-322-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEEC101088207V00000X
MA246996207V00000X
MEEC071063207V00000X
SD8360207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6201790Medicaid
SDS106428Medicare PIN