Provider Demographics
NPI:1215930318
Name:GEORGE, SUNU (MD)
Entity type:Individual
Prefix:
First Name:SUNU
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 E MAIN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1533
Mailing Address - Country:US
Mailing Address - Phone:317-889-0900
Mailing Address - Fax:317-889-0922
Practice Address - Street 1:916 E MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1533
Practice Address - Country:US
Practice Address - Phone:317-889-0900
Practice Address - Fax:317-889-0922
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059202A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00459132OtherRAILROAD MEDICARE PIN
IN200302750Medicaid
IN0175050001Medicare NSC
IN741720KMedicare ID - Type Unspecified
INI19308Medicare UPIN