Provider Demographics
NPI:1336110071
Name:SUNDAY, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:SUNDAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 JEFFERSON AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1639
Mailing Address - Country:US
Mailing Address - Phone:570-207-0433
Mailing Address - Fax:570-207-0436
Practice Address - Street 1:743 JEFFERSON AVE STE 303
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1639
Practice Address - Country:US
Practice Address - Phone:570-207-0433
Practice Address - Fax:570-207-0436
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042619L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014104240001Medicaid
PA742018Medicare ID - Type Unspecified
PAF55360Medicare UPIN