Provider Demographics
NPI:1447420724
Name:LAURA SUNN MD SC
Entity Type:Organization
Organization Name:LAURA SUNN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-886-5700
Mailing Address - Street 1:1055 PRAIRIE DR STE D
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3971
Mailing Address - Country:US
Mailing Address - Phone:262-898-7100
Mailing Address - Fax:232-898-7171
Practice Address - Street 1:5802 WASHINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4050
Practice Address - Country:US
Practice Address - Phone:262-886-5700
Practice Address - Fax:262-886-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26059-020261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30789900Medicaid
WI30789900Medicaid