Provider Demographics
NPI:1457570400
Name:ED SOUMI MD PC
Entity Type:Organization
Organization Name:ED SOUMI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-875-1111
Mailing Address - Street 1:11368 MERADO PEAK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1301
Mailing Address - Country:US
Mailing Address - Phone:702-875-1111
Mailing Address - Fax:702-341-6431
Practice Address - Street 1:5945 SOUTH RAINBOW BOULVARD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2560
Practice Address - Country:US
Practice Address - Phone:702-366-1764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV103780Medicare PIN
NVI43684Medicare UPIN