Healthcare Provider Details

I. General information

NPI: 1396914289
Provider Name (Legal Business Name): SUN HEALTH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14418 W MEEKER BLVD STE. 304
SUN CITY WEST AZ
85375-5283
US

IV. Provider business mailing address

PO BOX 1278 ATTN: MINDY OGDEN
SUN CITY AZ
85372-1278
US

V. Phone/Fax

Practice location:
  • Phone: 623-214-4400
  • Fax:
Mailing address:
  • Phone: 623-544-5075
  • Fax: 623-544-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL R BROSOR
Title or Position: VICE PRESIDENT, PHYSICIAN SERVICES
Credential:
Phone: 623-544-5079