Healthcare Provider Details

I. General information

NPI: 1043259666
Provider Name (Legal Business Name): MITCHELL KOLKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 JUPITER LAKES BLVD STE 103
JUPITER FL
33458-7187
US

IV. Provider business mailing address

8980 BIDDLE CT
WELLINGTON FL
33414-6436
US

V. Phone/Fax

Practice location:
  • Phone: 561-848-5579
  • Fax:
Mailing address:
  • Phone: 914-837-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME164698
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number231752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: