Healthcare Provider Details

I. General information

NPI: 1932990603
Provider Name (Legal Business Name): EMMA KOREN SOMMER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA KOREN WEIMER

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S LIBERTY DR
BLOOMINGTON IN
47403-5167
US

IV. Provider business mailing address

2263 DOUGLAS RD APT 423
MIAMI FL
33145-3261
US

V. Phone/Fax

Practice location:
  • Phone: 812-676-4500
  • Fax: 812-339-5436
Mailing address:
  • Phone: 614-961-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004859A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: