Provider Demographics
NPI:1255331625
Name:SUNGA, MARCOS N JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:N
Last Name:SUNGA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2467
Mailing Address - Street 2:
Mailing Address - City:ROSICLARE
Mailing Address - State:IL
Mailing Address - Zip Code:62982-2467
Mailing Address - Country:US
Mailing Address - Phone:618-285-6634
Mailing Address - Fax:618-285-3564
Practice Address - Street 1:1 FERRELL RD
Practice Address - Street 2:
Practice Address - City:ROSICLARE
Practice Address - State:IL
Practice Address - Zip Code:62982
Practice Address - Country:US
Practice Address - Phone:618-285-2800
Practice Address - Fax:618-285-2804
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL818810Medicare Oscar/Certification
C43012Medicare UPIN