MEDICARE: DR. NING SUN M.D., PHD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician		IL

General Provider Information

NPI Number	:	1124022900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NING SUN M.D., PHD.

Provider Business Mailing Address
First Line	:	6833 KINGERY HWY
Second Line	:
City	:	WILLOWBROOK
State	:	IL
Zip	:	60527-5154
Country	:	US
Telephone Number	:	630-321-9313
Fax Number	:	630-321-9314

Provider Business Practice Location Address
First Line	:	6833 KINGERY HWY
Second Line	:
City	:	WILLOWBROOK
State	:	IL
Zip	:	60527-5154
Country	:	US
Telephone Number	:	630-321-9313
Fax Number	:	630-321-9314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/23/2007

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