MEDICARE: LAURA SUNN MD SC

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	261Q00000X	Clinic/Center	26059-020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447420724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA SUNN MD SC

Provider Business Mailing Address
First Line	:	1055 PRAIRIE DR STE D
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-3971
Country	:	US
Telephone Number	:	262-898-7100
Fax Number	:	232-898-7171

Provider Business Practice Location Address
First Line	:	5802 WASHINGTON AVE STE 201
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-4050
Country	:	US
Telephone Number	:	262-886-5700
Fax Number	:	262-886-4747

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAURA A SUNN
Credential	:	M.D
Telephone Number	:	262-886-5700

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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