Provider Demographics
NPI:1356531065
Name:SOLSUN MEDICAL INC
Entity type:Organization
Organization Name:SOLSUN MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-627-9118
Mailing Address - Street 1:1451 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1033
Mailing Address - Country:US
Mailing Address - Phone:954-627-9118
Mailing Address - Fax:954-627-9822
Practice Address - Street 1:1451 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1033
Practice Address - Country:US
Practice Address - Phone:954-627-9118
Practice Address - Fax:954-627-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-29
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH610Medicare PIN