Provider Demographics
NPI:1932192457
Name:SOUMEKH, BENHOOR (MD)
Entity Type:Individual
Prefix:
First Name:BENHOOR
Middle Name:
Last Name:SOUMEKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3753
Mailing Address - Country:US
Mailing Address - Phone:612-871-1144
Mailing Address - Fax:612-871-2012
Practice Address - Street 1:2211 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3753
Practice Address - Country:US
Practice Address - Phone:612-871-1144
Practice Address - Fax:612-871-2012
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34277207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1000010OtherMEDICA PRIMARY
111715OtherUCARE
MN62D65S0OtherBLUE SHIELD
WI32281600Medicaid
MN1011165OtherPREFERRED ONE
MN639406000Medicaid
MN25905OtherAMERICA'S PPO
MN1000110OtherMEDICA CHOICE
MN111715OtherUCARE
MN62D65S0OtherBLUE SHIELD
WI32281600Medicaid