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NPI Code Detail

MEDICARE: FLORIDA WOMAN CARE, LLC

MEDICARE: FLORIDA WOMAN CARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033417589
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLORIDA WOMAN CARE, LLC
Provider Business Mailing Address
First Line : 4205 W ATLANTIC AVE
Second Line : SUITE C-304
City : DELRAY BEACH
State : FL
Zip : 33445-3901
Country : US
Telephone Number : 561-300-2410
Fax Number : 561-495-5408
Provider Business Practice Location Address
First Line : 7150 W 20TH AVE
Second Line : SUITE 615
City : HIALEAH
State : FL
Zip : 33016-5529
Country : US
Telephone Number : 305-512-4858
Fax Number : 305-817-8309
Authorized Official
Title or Position : PRESIDENT
Name : DR. KENNETH KONSKER
Credential : MD
Telephone Number : 561-300-2410
Provider Enumeration Date : 03/08/2011
Last Update Date : 03/08/2011

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Directions to “FLORIDA WOMAN CARE, LLC ” Practice Location

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