Provider Demographics
NPI:1508248766
Name:SK MEDICAL SERVICES OF SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:SK MEDICAL SERVICES OF SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-803-4352
Mailing Address - Street 1:15570 MARCELLO CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-2839
Mailing Address - Country:US
Mailing Address - Phone:414-803-4352
Mailing Address - Fax:
Practice Address - Street 1:15570 MARCELLO CIR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-2839
Practice Address - Country:US
Practice Address - Phone:414-803-4352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9322553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty