Healthcare Provider Details

I. General information

NPI: 1427894880
Provider Name (Legal Business Name): MIRA WOMEN'S HEALTH AND MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CLINT MOORE RD STE 210
BOCA RATON FL
33487-5716
US

IV. Provider business mailing address

1601 CLINT MOORE RD STE 210
BOCA RATON FL
33487-5716
US

V. Phone/Fax

Practice location:
  • Phone: 561-488-1801
  • Fax: 561-451-1480
Mailing address:
  • Phone: 561-488-1801
  • Fax: 561-451-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH A KONSKER
Title or Position: CEO AND PHYSICIAN
Credential: MD
Phone: 561-789-0559