Healthcare Provider Details

I. General information

NPI: 1851393581
Provider Name (Legal Business Name): KEITH ANDREW SKOLNICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 SOUTH PINE ISLAND RD. STE A100
PLANTATION FL
33324
US

IV. Provider business mailing address

PO BOX 39209
FT. LAUDERDALE FL
33339
US

V. Phone/Fax

Practice location:
  • Phone: 754-741-5555
  • Fax: 954-741-6298
Mailing address:
  • Phone: 954-851-9966
  • Fax: 954-318-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME80026
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME80026
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: