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
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1679870877
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	:	4850 W OAKLAND PARK BLVD
Second Line	:	SUITE 118
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-7268
Country	:	US
Telephone Number	:	954-485-1511
Fax Number	:	954-739-7948

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENNETH KONSKER
Credential	:	MD
Telephone Number	:	561-300-2410

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	03/04/2011

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