MEDICARE: DR. SUNU JOHN PHILIP MD

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	208600000X	Surgery Physician	273708	MA
2	208600000X	Surgery Physician	4301100177	MI
3	208600000X	Surgery Physician	MD-46733	IA

General Provider Information

NPI Number	:	1457610396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNU JOHN PHILIP MD

Provider Business Mailing Address
First Line	:	333 SERGEANT SQUARE DR UNIT 43
Second Line	:
City	:	SERGEANT BLUFF
State	:	IA
Zip	:	51054-7759
Country	:	US
Telephone Number	:	248-250-1087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 PIERCE ST STE 402
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3766
Country	:	US
Telephone Number	:	712-234-8725
Fax Number	:	712-234-8728

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

Provider Enumeration Date	:	05/13/2012
Last Update Date	:	07/08/2020

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