Provider Demographics
NPI:1417182254
Name:CRAIG G. SULTAN, D.O., P.A
Entity Type:Organization
Organization Name:CRAIG G. SULTAN, D.O., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:G
Authorized Official - Last Name:SULTAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-385-6620
Mailing Address - Street 1:2229 N COMMERCE PARKWAY
Mailing Address - Street 2:SUITRE 2E
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-385-6620
Mailing Address - Fax:
Practice Address - Street 1:2229 N COMMERCE PARKWAY
Practice Address - Street 2:SUITRE 2E
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-385-6620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG0057Medicare UPIN
FL57119Medicare PIN