Provider Demographics
NPI:1093127714
Name:UNIFIED MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:UNIFIED MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KONSKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-300-2410
Mailing Address - Street 1:3731 FAU BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6412
Mailing Address - Country:US
Mailing Address - Phone:561-300-2410
Mailing Address - Fax:866-263-4302
Practice Address - Street 1:3731 FAU BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6412
Practice Address - Country:US
Practice Address - Phone:561-300-2410
Practice Address - Fax:866-263-4302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIFIED PHYSICIAN MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70734207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty