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General NPI Number Information
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NPI Number | 1568641314
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Entity Type | Organization
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Legal Business Name | SUN LAKES HEALTH CARE, PC
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 10440 E RIGGS RD SUITE 170
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City | SUN LAKES
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State | AZ
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Zip | 85248-7751
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Country | US
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Telephone | 480-802-3433
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Fax | 480-802-3439
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Provider Business Mailing Address
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Address Line | 10440 E RIGGS RD SUITE 170
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City | SUN LAKES
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State | AZ
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Zip | 85248-7751
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Country | US
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Telephone | 480-802-3433
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Fax | 480-802-3439
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEPHEN H CLOAR
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Credential |
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Telephone | 480-802-3433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 6740
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License Number State | AZ
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