Healthcare Provider Details

I. General information

NPI: 1184691347
Provider Name (Legal Business Name): JULIE J SUNDARAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD METHODIST HOSPITAL
ST LOUIS PARK MN
55426
US

IV. Provider business mailing address

5435 FELTL RD
MINNETONKA MN
55343-7983
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-6080
  • Fax: 952-993-6047
Mailing address:
  • Phone: 952-835-9880
  • Fax: 952-857-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number67759-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number67759-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number45624
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number036.106776
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.106776
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: