Basic Information
| Provider Information | |||||||||
| NPI: | 1225328289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA WOMAN CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4205 W ATLANTIC AVE | ||||||||
| Address2: | SUITE C-304 | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334453901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613002410 | ||||||||
| FaxNumber: | 5614955408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1890 LPGA BLVD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321177130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862524701 | ||||||||
| FaxNumber: | 3862539410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | KONSKER | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5613002410 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.