Provider Demographics
NPI:1114110566
Name:SUNNI, MUNA (MBBCH)
Entity Type:Individual
Prefix:
First Name:MUNA
Middle Name:
Last Name:SUNNI
Suffix:
Gender:F
Credentials:MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:EAST BLDG, RM MB671
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55436
Mailing Address - Country:US
Mailing Address - Phone:612-624-5409
Mailing Address - Fax:612-626-5262
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:MMC 8404, 13-124 PHILLIPS WANGENSTEEN BUILDING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-624-5409
Practice Address - Fax:612-626-5262
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002802208000000X
MN52714390200000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program