Provider Demographics
NPI:1952317778
Name:SUNRISE PULMONARY GROUP INC
Entity Type:Organization
Organization Name:SUNRISE PULMONARY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYGALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-957-7171
Mailing Address - Street 1:6245 N FEDERAL HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1915
Mailing Address - Country:US
Mailing Address - Phone:954-957-7171
Mailing Address - Fax:954-745-0501
Practice Address - Street 1:7369 SHERIDAN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2776
Practice Address - Country:US
Practice Address - Phone:954-981-3700
Practice Address - Fax:954-987-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6392207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271236900Medicaid
FL271236900Medicaid