MEDICARE: MEDISUN MEDICAL CENTER 2 INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1780406926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDISUN MEDICAL CENTER 2 INC

Provider Business Mailing Address
First Line	:	3521 W BROWARD BLVD STE 107-108
Second Line	:
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33312-1048
Country	:	US
Telephone Number	:	954-281-0130
Fax Number	:	954-281-0129

Provider Business Practice Location Address
First Line	:	3521 W BROWARD BLVD STE 107-108
Second Line	:
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33312-1048
Country	:	US
Telephone Number	:	954-281-0130
Fax Number	:	954-281-0129

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MONICA SCHLOETER
Credential	:
Telephone Number	:	954-281-0130

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	02/27/2025

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