Provider Demographics
NPI:1528411865
Name:CRISTAL SUN MEDICAL GROUP
Entity Type:Organization
Organization Name:CRISTAL SUN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEN-KANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-781-2662
Mailing Address - Street 1:3470 E COAST AVE
Mailing Address - Street 2:APT 2005
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3470 E COAST AVE
Practice Address - Street 2:APT 2005
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3986
Practice Address - Country:US
Practice Address - Phone:305-781-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125973208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty