Provider Demographics
NPI:1578171047
Name:SANIBEL INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:SANIBEL INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, MANAGER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BUSSING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-395-2005
Mailing Address - Street 1:2495 PALM RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-3201
Mailing Address - Country:US
Mailing Address - Phone:239-395-2005
Mailing Address - Fax:239-395-0042
Practice Address - Street 1:2495 PALM RIDGE RD
Practice Address - Street 2:
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-3201
Practice Address - Country:US
Practice Address - Phone:239-395-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care