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:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18659 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-7388
Practice Address - Country:US
Practice Address - Phone:941-423-5035
Practice Address - Fax:941-423-5034
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6839195-1205207RC0001X
MN44397207RC0001X
FLME143717207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT060002274Medicare PIN
MN060002274Medicare PIN
CAG76010Medicare UPIN