MEDICARE: SAM J SUGAR MD FACP

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1780403394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAM J SUGAR MD FACP

Provider Business Mailing Address
First Line	:	5630 OAKTREE AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6375
Country	:	US
Telephone Number	:	847-571-4323
Fax Number	:

Provider Business Practice Location Address
First Line	:	5630 OAKTREE AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6375
Country	:	US
Telephone Number	:	847-571-4323
Fax Number	:	847-571-4323

Authorized Official
Title or Position	:	PHYSICIAN/SURGEON
Name	:	DR. SAM J SUGAR
Credential	:	MD
Telephone Number	:	847-571-4323

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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