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General NPI Number Information
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NPI Number | 1093127714
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Entity Type | Organization
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Legal Business Name | UNIFIED MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 3731 FAU BLVD
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City | BOCA RATON
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State | FL
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Zip | 33431-6412
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Country | US
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Telephone | 561-300-2410
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Fax | 866-263-4302
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Provider Business Mailing Address
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Address Line | 3731 FAU BLVD
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City | BOCA RATON
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State | FL
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Zip | 33431-6412
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Country | US
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Telephone | 561-300-2410
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Fax | 866-263-4302
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Authorized Official
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Title or Position | CO-CEO
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Name | DR. KENNETH ALAN KONSKER
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Credential | MD
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Telephone | 561-300-2410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME70734
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License Number State | FL
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