Provider Demographics
NPI:1457610396
Name:PHILIP, SUNU JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNU
Middle Name:JOHN
Last Name:PHILIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:333 SERGEANT SQUARE DR UNIT 43
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-7759
Mailing Address - Country:US
Mailing Address - Phone:248-250-1087
Mailing Address - Fax:
Practice Address - Street 1:2730 PIERCE ST STE 402
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3766
Practice Address - Country:US
Practice Address - Phone:712-234-8725
Practice Address - Fax:712-234-8728
Is Sole Proprietor?:No
Enumeration Date:2012-05-13
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA273708208600000X
MI4301100177208600000X
IAMD-46733208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery