Basic Information
| Provider Information | |||||||||
| NPI: | 1245658855 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SUNJIC | ||||||||
| FirstName: | IGOR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 PINELLAS ST | ||||||||
| Address2: | STE 400 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274451992 | ||||||||
| FaxNumber: | 7274451993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 MEASE DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346956604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277256246 | ||||||||
| FaxNumber: | 7277265865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2014 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME135920 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 107273000 | 05 | FL | MEDICAID |