MEDICARE: FLORIDA WOMAN CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356648547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA WOMAN CARE LLC

Provider Business Mailing Address
First Line	:	4205 W ATLANTIC AVE
Second Line	:	SUITE C304
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3901
Country	:	US
Telephone Number	:	561-300-2410
Fax Number	:	561-495-5408

Provider Business Practice Location Address
First Line	:	836 PRUDENTIAL DR
Second Line	:	SUITE 1506
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8342
Country	:	US
Telephone Number	:	904-346-0050
Fax Number	:	904-307-9385

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH KONSKER
Credential	:	MD
Telephone Number	:	561-300-2410

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	03/04/2011

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