Provider Demographics
NPI:1235242405
Name:SUN, MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W 15TH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7751
Mailing Address - Country:US
Mailing Address - Phone:972-596-1803
Mailing Address - Fax:972-867-4970
Practice Address - Street 1:3900 W 15TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7751
Practice Address - Country:US
Practice Address - Phone:972-596-1803
Practice Address - Fax:972-867-4970
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH68972Medicare UPIN
TX8255B9Medicare PIN