Provider Demographics
NPI:1790971349
Name:LEONARD SUKIENIK DOPA
Entity Type:Organization
Organization Name:LEONARD SUKIENIK DOPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKIENIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-784-0473
Mailing Address - Street 1:13005 SOUTHERN BLVD
Mailing Address - Street 2:221
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9206
Mailing Address - Country:US
Mailing Address - Phone:561-784-0473
Mailing Address - Fax:561-784-9038
Practice Address - Street 1:13005 SOUTHERN BLVD
Practice Address - Street 2:221
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9206
Practice Address - Country:US
Practice Address - Phone:561-784-0473
Practice Address - Fax:561-784-9038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006932207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4470Medicare PIN