MEDICARE: SUNFOREST ORTHOPEDICS 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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962593707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNFOREST ORTHOPEDICS INC

Provider Business Mailing Address
First Line	:	4405 N HOLLAND SYLVANIA RD
Second Line	:	SUITE 101
City	:	TOLEDO
State	:	OH
Zip	:	43623-3529
Country	:	US
Telephone Number	:	419-475-1600
Fax Number	:	419-475-2104

Provider Business Practice Location Address
First Line	:	4405 N HOLLAND SYLVANIA RD
Second Line	:	SUITE 101
City	:	TOLEDO
State	:	OH
Zip	:	43623-3529
Country	:	US
Telephone Number	:	419-475-1600
Fax Number	:	419-475-2104

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. ELAINE WIELAND
Credential	:
Telephone Number	:	419-475-1600

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	02/05/2008

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Directions to “SUNFOREST ORTHOPEDICS INC ” Practice Location

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