Individual
GEORGE SUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
430 N PLEASANT AVE, CENTRALIA, IL 62801-3006
(618) 436-8350
(618) 532-9347
Mailing address
430 N PLEASANT AVE, CENTRALIA, IL 62801-3006
(618) 436-8350
(618) 532-9347
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207988
GROUP
IL
01
—
CH4443
RR GROUP NUMBER
IL
01
—
P00180554
RR MEDICARE NUMBER
IL
Enumeration date
06/05/2006
Last updated
11/27/2007
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