Provider Demographics
NPI:1033388939
Name:KONDRACKA, ELIZABETH TERESA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:TERESA
Last Name:KONDRACKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 COASTAL HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2751
Mailing Address - Country:US
Mailing Address - Phone:321-777-5152
Mailing Address - Fax:321-777-5152
Practice Address - Street 1:226 COASTAL HILL DRIVE
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2751
Practice Address - Country:US
Practice Address - Phone:321-777-5152
Practice Address - Fax:321-777-5152
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0699039Medicaid
FL0699039Medicaid
FL05540Medicare UPIN