Provider Demographics
NPI:1710201470
Name:SUNRISE MEDICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:SUNRISE MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-996-5284
Mailing Address - Street 1:989 UNIVERSITY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1885
Mailing Address - Country:US
Mailing Address - Phone:248-996-5284
Mailing Address - Fax:
Practice Address - Street 1:989 UNIVERSITY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-1885
Practice Address - Country:US
Practice Address - Phone:248-996-5284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086699172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty