Provider Demographics
NPI:1922066802
Name:SUNBY, CARL R (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:R
Last Name:SUNBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 N HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3676
Mailing Address - Country:US
Mailing Address - Phone:608-843-3746
Mailing Address - Fax:
Practice Address - Street 1:1404 N HIGH POINT RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3676
Practice Address - Country:US
Practice Address - Phone:608-843-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32957-020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2932OtherDEAN HEALTH INSURANCE
WI31790100Medicaid
E86302Medicare UPIN
WI2932OtherDEAN HEALTH INSURANCE
WI020021900Medicare PIN