Ann Marie Sundareson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

46090 Issued in WI

Practice address

6809 122ND Ave
Kenosha, WI 53142-7335

Phone

(262) 654-8633

Fax

(262) 654-5467

NPI assigned

Sep 13, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: asundareson347671@direct.froedtert.com
• Direct secure messaging: asundareson12215@direct.chw.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Medical Group

  • Pediatrics Physician
  • Glendale, WI
  • NPI 1134394471
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550016000000",
    "number": "1023003373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE # MS 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6809 122ND AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427335",
            "telephone_number": "262-654-8633",
            "fax_number": "262-654-5467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDARESON",
        "first_name": "ANN MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-13",
        "last_updated": "2019-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "46090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34469300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer J Struc, PTA
• Elisabeth Strutz, APNP
• Keith A Stummer, D.D.S.
• Daniel P Sturm, PA-C
• Sue Panger & Associates, SC
• Paul Jiyoung Sung, DDS
• Sunstone Assisted Living LLC
• Superior Health and Wellness of Gurnee, LTD
• Suresh R Naik MD SC
• Suresh R Naikmd SC

• Pediatrics Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Pediatrics Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.