Provider Demographics
NPI:1639375165
Name:SUN 'N LAKE MEDICAL GROUP,PA
Entity Type:Organization
Organization Name:SUN 'N LAKE MEDICAL GROUP,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BELTRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-385-2659
Mailing Address - Street 1:4958 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2167
Mailing Address - Country:US
Mailing Address - Phone:863-385-8004
Mailing Address - Fax:863-385-2330
Practice Address - Street 1:4958 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2167
Practice Address - Country:US
Practice Address - Phone:863-385-8004
Practice Address - Fax:863-385-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1104923374OtherNPI
FL373302500Medicaid
FL1740270545OtherNPI
FL1760505457OtherNPI
FL1467461905OtherNPI
FL1427048495OtherNPI
FL373963500Medicaid
FL1760505457OtherNPI