Organization
SUNRISE CLINICAL LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIFTAH KEMAL M.S. (OWNER)
(941) 624-3005
Entity
Organization
Contact information
Practice address
21216 OLEAN BLVD, 3, PORT CHARLOTTE, FL 33952-6722
(941) 624-3005
(941) 624-6405
Mailing address
21216 OLEAN BLVD, 3, PORT CHARLOTTE, FL 33952-6722
(941) 624-3005
(941) 624-6405
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L9263
BCBS
FL
Enumeration date
09/12/2005
Last updated
10/22/2007
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