MEDICARE: DR. JOEL ROBERT SUKONIK MD

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
1	207Q00000X	Family Medicine Physician	ME64601	FL

General Provider Information

NPI Number	:	1225078017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL ROBERT SUKONIK MD

Provider Business Mailing Address
First Line	:	323 S HEATHWOOD DR
Second Line	:
City	:	MARCO ISLAND
State	:	FL
Zip	:	34145-5031
Country	:	US
Telephone Number	:	239-970-0797
Fax Number	:

Provider Business Practice Location Address
First Line	:	26800 S TAMIAMI TRL
Second Line	:	#150
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4349
Country	:	US
Telephone Number	:	239-344-2309
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	01/09/2014

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