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General NPI Number Information
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NPI Number | 1356011357
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Entity Type | Organization
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Legal Business Name | SUNBURST CARDIOLOGY LLC
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 13710 METROPOLIS AVE STE 108
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City | FORT MYERS
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State | FL
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Zip | 33912-7144
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Country | US
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Telephone | 239-306-8388
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Fax | 239-208-4938
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Provider Business Mailing Address
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Address Line | 13710 METROPOLIS AVE STE 108
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City | FORT MYERS
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State | FL
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Zip | 33912-7144
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Country | US
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Telephone | 239-306-8388
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Fax | 239-208-4938
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Authorized Official
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Title or Position | CARDIOLOGIST
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Name | DR. JOHN RUSSELL MACALUSO
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Credential | MD
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Telephone | 239-306-8388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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