1821186230 NPI number — DR. JULIE KONOWITZ SIRKIN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821186230 NPI number — DR. JULIE KONOWITZ SIRKIN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KONOWITZ SIRKIN

Provider First Name:

JULIE

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1821186230

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/26/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

160 JFK DR STE 101

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ATLANTIS

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33462-6638

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

561-964-1215

Provider Business Mailing Address Fax Number:

561-964-1245

Provider First Line Business Practice Location Address:

9868 S STATE ROAD 7 STE 305

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BOYNTON BEACH

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33472-4475

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

561-369-0111

Provider Business Practice Location Address Fax Number:

561-369-4003

Provider Enumeration Date:

10/11/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  84037 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 7539386 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 15675 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 263544500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 8159487004 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: SG033359 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 000004206965 . This is a "HEALTHY PALM BEACHES" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 041634 . This is a "NHP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 21221016506 . This is a "BEECHSTREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 284509 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 176914 . This is a "SFCN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 244824 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 263544500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".