Provider Demographics
NPI:1225078017
Name:SUKONIK, JOEL ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ROBERT
Last Name:SUKONIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S HEATHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-5031
Mailing Address - Country:US
Mailing Address - Phone:239-970-0797
Mailing Address - Fax:
Practice Address - Street 1:26800 S TAMIAMI TRL
Practice Address - Street 2:#150
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4349
Practice Address - Country:US
Practice Address - Phone:239-344-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB31677Medicare UPIN
FL62946ZMedicare ID - Type UnspecifiedMEDICARE