Provider Demographics
NPI:1861734824
Name:SUNSHINE PRIMARY CARE LLC
Entity type:Organization
Organization Name:SUNSHINE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GHIATH
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-792-1900
Mailing Address - Street 1:17921 HUNTING BOW CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5379
Mailing Address - Country:US
Mailing Address - Phone:813-792-1900
Mailing Address - Fax:
Practice Address - Street 1:17921 HUNTING BOW CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5379
Practice Address - Country:US
Practice Address - Phone:813-792-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-17
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI18173Medicare UPIN