Provider Demographics
NPI:1356011357
Name:SUNBURST CARDIOLOGY LLC
Entity Type:Organization
Organization Name:SUNBURST CARDIOLOGY LLC
Other - Org Name:SUNBURST CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MACALUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-306-8388
Mailing Address - Street 1:13710 METROPOLIS AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7144
Mailing Address - Country:US
Mailing Address - Phone:239-306-8388
Mailing Address - Fax:239-208-4938
Practice Address - Street 1:13710 METROPOLIS AVE STE 108
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7144
Practice Address - Country:US
Practice Address - Phone:239-306-8388
Practice Address - Fax:239-208-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty