Healthcare Provider Details

I. General information

NPI: 1578171047
Provider Name (Legal Business Name): SANIBEL INTERNAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 PALM RIDGE RD
SANIBEL FL
33957-3201
US

IV. Provider business mailing address

2495 PALM RIDGE RD
SANIBEL FL
33957-3201
US

V. Phone/Fax

Practice location:
  • Phone: 239-395-2005
  • Fax:
Mailing address:
  • Phone: 239-395-2005
  • Fax: 239-395-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT C BUSSING
Title or Position: CO-OWNER, MANAGER, PHYSICIAN
Credential: MD
Phone: 239-395-2005