MEDICARE: SUN HEALTH MEDICAL GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1487824330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN HEALTH MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1278
Second Line	:	ATTN: MINDY OGDEN
City	:	SUN CITY
State	:	AZ
Zip	:	85372-1278
Country	:	US
Telephone Number	:	623-544-5075
Fax Number	:	623-544-5093

Provider Business Practice Location Address
First Line	:	13188 N 103RD DR
Second Line	:	SUITE 206
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3064
Country	:	US
Telephone Number	:	623-972-3001
Fax Number	:	623-933-3045

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	PAUL R BROSOR
Credential	:
Telephone Number	:	623-544-5079

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	03/06/2008

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Directions to “SUN HEALTH MEDICAL GROUP, LLC ” Practice Location

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