Provider Demographics
NPI:1609819382
Name:EAPEN, SUNU S (MD)
Entity Type:Individual
Prefix:MS
First Name:SUNU
Middle Name:S
Last Name:EAPEN
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 1:1350 SUNNY SLOPE ROAD
Mailing Address - Street 2:SUNNYSLOPE PRIMARY CARE CLINIC
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:414-805-9600
Mailing Address - Fax:414-805-9659
Practice Address - Street 1:1350 SUNNY SLOPE ROAD
Practice Address - Street 2:SUNNYSLOPE PRIMARY CARE CLINIC
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:414-805-9600
Practice Address - Fax:414-805-9659
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1609819382Medicaid
WI1609819382Medicaid
F91145Medicare UPIN
WI029668086Medicare PIN