Provider Demographics
NPI:1003167362
Name:SUNRISE LASER & HORMONE INSTITUTE
Entity Type:Organization
Organization Name:SUNRISE LASER & HORMONE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-748-4302
Mailing Address - Street 1:2500 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3003
Mailing Address - Country:US
Mailing Address - Phone:954-748-4302
Mailing Address - Fax:954-748-4304
Practice Address - Street 1:2500 N UNIVERSITY DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3003
Practice Address - Country:US
Practice Address - Phone:954-748-4302
Practice Address - Fax:954-748-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty