Provider Demographics
NPI:1487182770
Name:SUNRISE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SUNRISE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALALAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-775-5879
Mailing Address - Street 1:PO BOX 3806
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-3806
Mailing Address - Country:US
Mailing Address - Phone:419-775-5879
Mailing Address - Fax:844-520-5975
Practice Address - Street 1:370 CLINE AVE STE B3
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1057
Practice Address - Country:US
Practice Address - Phone:419-775-5879
Practice Address - Fax:844-520-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty