Provider Demographics
NPI:1629271671
Name:PROSPER, SOUMATHY C (MD)
Entity Type:Individual
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First Name:SOUMATHY
Middle Name:C
Last Name:PROSPER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:952-587-4885
Practice Address - Street 1:530 3RD ST NW - MAIL STOP 39400A
Practice Address - Street 2:RIVERWAY CLINIC - ELK RIVER
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-8863
Practice Address - Country:US
Practice Address - Phone:763-587-4800
Practice Address - Fax:763-587-4885
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2011-12-01
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Provider Licenses
StateLicense IDTaxonomies
MN103102207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology