Healthcare Provider Details

I. General information

NPI: 1144894486
Provider Name (Legal Business Name): SUNRISE MA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 259C
SAINT LOUIS MO
63131-2308
US

IV. Provider business mailing address

1389 BRINSTON CT
BALLWIN MO
63011-2903
US

V. Phone/Fax

Practice location:
  • Phone: 618-696-6938
  • Fax:
Mailing address:
  • Phone: 618-696-6938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAKIN UDDIN AHMED
Title or Position: SOLO
Credential: MD
Phone: 618-696-6938