Healthcare Provider Details

I. General information

NPI: 1952317778
Provider Name (Legal Business Name): SUNRISE PULMONARY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7369 SHERIDAN ST SUITE 302
HOLLYWOOD FL
33024-2776
US

IV. Provider business mailing address

6245 N FEDERAL HWY SUITE 300
FORT LAUDERDALE FL
33308-1915
US

V. Phone/Fax

Practice location:
  • Phone: 954-981-3700
  • Fax: 954-987-4414
Mailing address:
  • Phone: 954-957-7171
  • Fax: 954-745-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberHCC6392
License Number StateFL

VIII. Authorized Official

Name: GIOVANNE ZYGALA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 954-957-7171