| Shield Medical Group Pllc | |
|
4597 Casablanca Cir Sebring FL 33870-1206 | |
| (863) 236-9550 | |
| (877) 832-3363 |
| Full Name | Shield Medical Group Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4597 Casablanca Cir, Sebring, Florida |
| Authorized Official Name and Position | Kulmeet S Kundlas (PRESIDENT) |
| Authorized Official Contact | 8632559595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shield Medical Group Pllc Po Box 919558 Orlando FL 32891-9558 Ph: (863) 236-9550 | Shield Medical Group Pllc 4597 Casablanca Cir Sebring FL 33870-1206 Ph: (863) 236-9550 |
| NPI Number | 1184125338 |
|---|---|
| Provider Enumeration Date | 02/23/2018 |
| Last Update Date | 04/06/2022 |
| Medicare PECOS PAC ID | 0648534479 |
|---|---|
| Medicare Enrollment ID | O20180503000441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184125338 | NPI | - | NPPES |
| 252638700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME73743 (Florida) | Primary |
| Provider Name | Sukumar Mathan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386798452 PECOS PAC ID: 1254399355 Enrollment ID: I20041221000472 |
| Provider Name | Kulmeet S Kundlas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336293497 PECOS PAC ID: 7911965132 Enrollment ID: I20041221000481 |
| Provider Name | Luis Rodriguez Gonzalez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1770504565 PECOS PAC ID: 4789606112 Enrollment ID: I20220829003783 |
| Provider Name | Carlos Baez Cubille |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1225082068 PECOS PAC ID: 0749467421 Enrollment ID: I20230919004117 |
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