Provider Demographics
NPI:1487617593
Name:SUN, MARK Y (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:Y
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3433 BROADWAY ST NE STE 115
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1759
Mailing Address - Country:US
Mailing Address - Phone:651-312-1505
Mailing Address - Fax:651-312-1570
Practice Address - Street 1:11850 BLACKFOOT ST NW
Practice Address - Street 2:SUITE 270
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2578
Practice Address - Country:US
Practice Address - Phone:651-312-1717
Practice Address - Fax:651-312-1570
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-02-27
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Provider Licenses
StateLicense IDTaxonomies
MA222062208600000X
MN53998208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery