MEDICARE: SUN MEDICAL GROUP

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	174400000X	Specialist

General Provider Information

NPI Number	:	1306881461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1753 E BROADWAY RD
Second Line	:	SUITE 101-268
City	:	TEMPE
State	:	AZ
Zip	:	85282-2081
Country	:	US
Telephone Number	:	480-831-7601
Fax Number	:

Provider Business Practice Location Address
First Line	:	2034 E SOUTHERN AVE
Second Line	:	SUITE M
City	:	TEMPE
State	:	AZ
Zip	:	85282-7522
Country	:	US
Telephone Number	:	480-831-7601
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. LINDA H. STARR
Credential	:
Telephone Number	:	800-836-2904

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/22/2020

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