MEDICARE: SOLSUN MEDICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS0003995	FL

General Provider Information

NPI Number	:	1356531065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLSUN MEDICAL INC

Provider Business Mailing Address
First Line	:	1451 NE 4TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1033
Country	:	US
Telephone Number	:	954-627-9118
Fax Number	:	954-627-9822

Provider Business Practice Location Address
First Line	:	1451 NE 4TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1033
Country	:	US
Telephone Number	:	954-627-9118
Fax Number	:	954-627-9822

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DONALD D FISHER
Credential	:	DO
Telephone Number	:	954-627-9118

Provider Enumeration Date	:	07/29/2007
Last Update Date	:	12/03/2008

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