Healthcare Provider Details

I. General information

NPI: 1316140262
Provider Name (Legal Business Name): JORGE KONOPKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JORGE CURBELO KONOPKA M.D.

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 SW 172ND AVE SUITE 312
MIRAMAR FL
33029
US

IV. Provider business mailing address

1951 SW 172ND AVE SUITE 312
MIRAMAR FL
33029-5593
US

V. Phone/Fax

Practice location:
  • Phone: 954-320-7999
  • Fax: 954-320-7601
Mailing address:
  • Phone: 954-320-7999
  • Fax: 954-320-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME103846
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME103846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: