MEDICARE: SUNBELT MEDICAL MANAGEMENT

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1972438349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNBELT MEDICAL MANAGEMENT

Provider Business Mailing Address
First Line	:	2850 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1910
Country	:	US
Telephone Number	:	520-322-6274
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1910
Country	:	US
Telephone Number	:	520-322-6274
Fax Number	:

Authorized Official
Title or Position	:	MSO DIRECTOR
Name	:	GWENDOLYN MISEVCH
Credential	:
Telephone Number	:	520-423-5600

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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