Healthcare Provider Details

I. General information

NPI: 1972438349
Provider Name (Legal Business Name): SUNBELT MEDICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 N COUNTRY CLUB RD
TUCSON AZ
85716-1910
US

IV. Provider business mailing address

2850 N COUNTRY CLUB RD
TUCSON AZ
85716-1910
US

V. Phone/Fax

Practice location:
  • Phone: 520-322-6274
  • Fax:
Mailing address:
  • Phone: 520-322-6274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: GWENDOLYN MISEVCH
Title or Position: MSO DIRECTOR
Credential:
Phone: 520-423-5600