Provider Demographics
NPI:1649451667
Name:FOLKMAN, LAURIE J (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:FOLKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 MONDALE CT
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-3114
Mailing Address - Country:US
Mailing Address - Phone:813-245-2258
Mailing Address - Fax:
Practice Address - Street 1:2440 MONDALE CT
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3114
Practice Address - Country:US
Practice Address - Phone:813-245-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09672Medicare PIN