Provider Demographics
NPI:1093484743
Name:MD HEALTHCARE SUNRISE
Entity Type:Organization
Organization Name:MD HEALTHCARE SUNRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERBURGER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:786-229-9733
Mailing Address - Street 1:304 INDIAN TRCE STE 636
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2996
Mailing Address - Country:US
Mailing Address - Phone:954-578-0200
Mailing Address - Fax:
Practice Address - Street 1:4269 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6044
Practice Address - Country:US
Practice Address - Phone:954-578-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty