Provider Demographics
NPI:1427610815
Name:SUNSHINE ANESTHESIA & WELLNESS MEDICAL GROUP LLC
Entity type:Organization
Organization Name:SUNSHINE ANESTHESIA & WELLNESS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOGIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTOINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-836-1421
Mailing Address - Street 1:4997 SW 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4956
Mailing Address - Country:US
Mailing Address - Phone:305-386-3967
Mailing Address - Fax:305-386-3969
Practice Address - Street 1:4997 SW 162ND AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4956
Practice Address - Country:US
Practice Address - Phone:305-386-3967
Practice Address - Fax:305-386-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265702300Medicaid