Provider Demographics
NPI:1528365715
Name:FLORIDA WOMAN CARE, LLC
Entity Type:Organization
Organization Name:FLORIDA WOMAN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KONSKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-300-2410
Mailing Address - Street 1:4205 W ATLANTIC AVE
Mailing Address - Street 2:SUITE C-304
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3901
Mailing Address - Country:US
Mailing Address - Phone:561-300-2410
Mailing Address - Fax:561-495-5408
Practice Address - Street 1:1325 S CONGRESS AVE
Practice Address - Street 2:SUITE 115-116
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5874
Practice Address - Country:US
Practice Address - Phone:561-734-4545
Practice Address - Fax:561-734-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001553512Medicaid