Provider Demographics
NPI:1851393581
Name:SKOLNICK, KEITH ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ANDREW
Last Name:SKOLNICK
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:PO BOX 39209
Mailing Address - Street 2:
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339
Mailing Address - Country:US
Mailing Address - Phone:954-851-9966
Mailing Address - Fax:954-318-7360
Practice Address - Street 1:850 SOUTH PINE ISLAND RD.
Practice Address - Street 2:STE A100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:754-741-5555
Practice Address - Fax:954-741-6298
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80026174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL180041647OtherRAILROAD MEDICARE
FL271132OtherCOMPBENEFITS CORPORATION
FL49945OtherBLUE CROSS BLUE SHEILD
FL650560968OtherHUMANA
FL2436810OtherAETNA
FL259102200Medicaid
FL271132OtherAVMED
FL650560968OtherCIGNA
FL650560968OtherUNITED
FL49945ZMedicare PIN
FL271132OtherCOMPBENEFITS CORPORATION
FL180041647OtherRAILROAD MEDICARE