Provider Demographics
NPI:1689624728
Name:SOMASUNDARAM, PORUR E (MD)
Entity Type:Individual
Prefix:DR
First Name:PORUR
Middle Name:E
Last Name:SOMASUNDARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:915 E 1ST ST
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2107
Mailing Address - Country:US
Mailing Address - Phone:218-249-6839
Mailing Address - Fax:218-249-6880
Practice Address - Street 1:915 E 1ST ST
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2107
Practice Address - Country:US
Practice Address - Phone:218-249-6839
Practice Address - Fax:218-249-6880
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN44397207RC0001X
UT6839195-1205207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT060002274Medicare PIN
MN060002274Medicare PIN
CAG76010Medicare UPIN