Provider Demographics
NPI:1063958890
Name:SUNLIGHT MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:SUNLIGHT MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHUKWUMA
Authorized Official - Last Name:ODIBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-228-5894
Mailing Address - Street 1:1099 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 100-A
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7346
Mailing Address - Country:US
Mailing Address - Phone:910-228-5894
Mailing Address - Fax:910-228-5897
Practice Address - Street 1:1099 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 100-A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7346
Practice Address - Country:US
Practice Address - Phone:910-228-5894
Practice Address - Fax:910-228-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01360261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care