Provider Demographics
NPI:1972700359
Name:SUNRISE INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:SUNRISE INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:F
Authorized Official - Last Name:LUO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-486-9696
Mailing Address - Street 1:22707 S. ELLSWORTH RD.
Mailing Address - Street 2:SUITE #H105
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-6119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22707 S. ELLSWORTH RD.
Practice Address - Street 2:SUITE #H105
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty