Provider Demographics
NPI:1215627526
Name:CORNERSTONE MEDICAL GROUP INC
Entity type:Organization
Organization Name:CORNERSTONE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SABINE
Authorized Official - Middle Name:DELINOIS
Authorized Official - Last Name:ELISEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-372-0179
Mailing Address - Street 1:8896 ROYAL PALM BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5803
Mailing Address - Country:US
Mailing Address - Phone:954-372-0179
Mailing Address - Fax:
Practice Address - Street 1:8896 ROYAL PALM BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5803
Practice Address - Country:US
Practice Address - Phone:954-372-0179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty