Provider Demographics
NPI:1649323247
Name:GEORGE, SUSHIL C (MD)
Entity type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:C
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 N WEST SHORE BLVD
Mailing Address - Street 2:SUITE 780
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-3925
Mailing Address - Country:US
Mailing Address - Phone:813-440-4404
Mailing Address - Fax:
Practice Address - Street 1:2385 TAMPA RD STE 4
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5851
Practice Address - Country:US
Practice Address - Phone:727-789-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI07302Medicare UPIN
FLU2477ZMedicare ID - Type Unspecified