=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972505667
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ALLEN ARZOUMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2005
-----------------------------------------------------
Last Update Date | 05/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 EAST 3RD STREET SMDC MEDICAL CENTER-DULUTH CLINIC
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-786-3900
-----------------------------------------------------
Fax | 715-552-8091
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 EAST 3RD STREET SMDC MEDICAL CENTER-DULUTH CLINIC
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-786-3900
-----------------------------------------------------
Fax | 715-552-8091
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | 23550
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | 53532
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------