Provider Demographics
NPI:1407148539
Name:STARLIGHT MEDICAL GROUP & SLEEP LAB LLC
Entity Type:Organization
Organization Name:STARLIGHT MEDICAL GROUP & SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:813-610-6516
Mailing Address - Street 1:7132 WAREHAM DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1132
Mailing Address - Country:US
Mailing Address - Phone:813-610-6516
Mailing Address - Fax:
Practice Address - Street 1:2621 WINDGUARD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7354
Practice Address - Country:US
Practice Address - Phone:813-994-2729
Practice Address - Fax:813-994-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-08
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty