Healthcare Provider Details

I. General information

NPI: 1467127993
Provider Name (Legal Business Name): WILKENS MONDESIR MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 W BOYNTON BEACH BLVD STE 5
BOYNTON BEACH FL
33436-4540
US

IV. Provider business mailing address

4849 LAKE WORTH RD STE 201
GREENACRES FL
33463-3462
US

V. Phone/Fax

Practice location:
  • Phone: 561-734-1212
  • Fax: 561-734-1443
Mailing address:
  • Phone: 561-784-7014
  • Fax: 561-784-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: WILKENS MONDESIR
Title or Position: OWNER
Credential: MD
Phone: 561-784-7014