Individual
RUIDONG SUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 BROADWAY, FORT WAYNE, IN 46802-1402
(260) 969-1950
(260) 969-0988
Mailing address
10351 DAWSONS CREEK BLVD, SUITE D, FORT WAYNE, IN 46825-1904
(260) 969-1950
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01063317
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000511776
ANTHEM
IN
05
—
200856520
—
IN
01
—
P00379083
RAILROAD MEDICARE
IN
Enumeration date
03/12/2007
Last updated
11/25/2009
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