Provider Demographics
NPI:1164398806
Name:COASTAL SHORELINE MEDICAL GROUP
Entity type:Organization
Organization Name:COASTAL SHORELINE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORSHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-944-9365
Mailing Address - Street 1:12522 ROCKROSE GLN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2827
Mailing Address - Country:US
Mailing Address - Phone:813-944-9365
Mailing Address - Fax:
Practice Address - Street 1:12522 ROCKROSE GLN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2827
Practice Address - Country:US
Practice Address - Phone:813-944-9365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty