Provider Demographics
NPI:1891933784
Name:SUNNYBROOK PHYSICIANS AND REHAB GROPUP PC
Entity Type:Organization
Organization Name:SUNNYBROOK PHYSICIANS AND REHAB GROPUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-274-1019
Mailing Address - Street 1:5740 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4249
Mailing Address - Country:US
Mailing Address - Phone:712-274-1019
Mailing Address - Fax:712-274-8909
Practice Address - Street 1:5740 SUNNYBROOK DRIVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4249
Practice Address - Country:US
Practice Address - Phone:712-274-1019
Practice Address - Fax:712-274-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1164402210OtherNPI
IA1487634259OtherNPI
IA1952380750OtherNPI
IA1487633285OtherNPI