Healthcare Provider Details

I. General information

NPI: 1669480372
Provider Name (Legal Business Name): ALLAN B SOLUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 1ST ST
PAYNESVILLE MN
56362-1445
US

IV. Provider business mailing address

29011 DORCHESTER LN
PAYNESVILLE MN
56362-9324
US

V. Phone/Fax

Practice location:
  • Phone: 320-243-3779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMN19757
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: