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General NPI Number Information
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NPI Number | 1407148539
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Entity Type | Organization
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Legal Business Name | STARLIGHT MEDICAL GROUP & SLEEP LAB LLC
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Dates
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Enumeration Date | 05/08/2011
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Last Update Date | 05/08/2011
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Provider Practice Location Address
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Address Line | 2621 WINDGUARD CIR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7354
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Country | US
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Telephone | 813-994-2729
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Fax | 813-994-2965
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Provider Business Mailing Address
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Address Line | 7132 WAREHAM DR
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City | TAMPA
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State | FL
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Zip | 33647-1132
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Country | US
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Telephone | 813-610-6516
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN K EVANS
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Credential | MBA
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Telephone | 813-610-6516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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