Provider Demographics
NPI:1669449260
Name:SUNDERHAUS, PAUL THOMAS (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:SUNDERHAUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1587 N BOLTON AVE
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-4205
Mailing Address - Country:US
Mailing Address - Phone:318-445-9210
Mailing Address - Fax:318-445-1509
Practice Address - Street 1:1587 N BOLTON AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-4205
Practice Address - Country:US
Practice Address - Phone:318-445-9210
Practice Address - Fax:318-445-1509
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPMPD205R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1532924Medicaid
LA480025072OtherRAILROAD MEDICARE-PALMETT
U67958Medicare UPIN
LA5Y886F735Medicare ID - Type Unspecified