Provider Demographics
NPI:1215020839
Name:STYPEREK GROHMANN, KINGA E (MD)
Entity Type:Individual
Prefix:DR
First Name:KINGA
Middle Name:E
Last Name:STYPEREK GROHMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KINGA
Other - Middle Name:EVA
Other - Last Name:STYPEREK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2314 S. SEACREST BLVD., SUITE 102
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6788
Mailing Address - Country:US
Mailing Address - Phone:561-732-1586
Mailing Address - Fax:561-732-3160
Practice Address - Street 1:2314 S. SEACREST BLVD., SUITE 102
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6788
Practice Address - Country:US
Practice Address - Phone:561-732-1586
Practice Address - Fax:561-732-3160
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85822208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH73077Medicare UPIN
FLK3914Medicare ID - Type UnspecifiedGROUP PROV#
FL47884ZMedicare ID - Type UnspecifiedINDIVIDUAL ID#