Provider Demographics
NPI:1447243944
Name:SUNN, LAURA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:SUNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9461 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-4810
Mailing Address - Country:US
Mailing Address - Phone:262-914-1813
Mailing Address - Fax:847-731-1093
Practice Address - Street 1:2520 ELISHA AVENUE
Practice Address - Street 2:MIDWESTERN REGIONAL MEDICAL CENTER
Practice Address - City:ZIO
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:262-914-1813
Practice Address - Fax:847-731-1093
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12432084P0800X
IL0361317262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30789900Medicaid
WI30789900Medicaid
WIWI1258001Medicare PIN