Healthcare Provider Details

I. General information

NPI: 1023215050
Provider Name (Legal Business Name): LAURA WHITE KOLSHAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA E WHITE MD

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 S CONGRESS AVE
PALM SPRINGS FL
33406-7620
US

IV. Provider business mailing address

2237 S CONGRESS AVE
PALM SPRINGS FL
33406-7620
US

V. Phone/Fax

Practice location:
  • Phone: 561-508-7066
  • Fax: 561-508-5738
Mailing address:
  • Phone: 561-801-1154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME 102418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: