Konicki, Mark

Konicki, Mark is an individual health care provider with primary practice located at 820 Prudential Dr Ste 304 , Jacksonville FL 32207-8205. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Konicki, Mark can be contacted via phone (904) 364-3649.

Contact Information

Primary practice address
820 Prudential Dr Ste 304 Jacksonville FL 32207-8205
Phone: (904) 364-3649
Fax: (904) 357-5627
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X ME60881 Florida
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 01071892A Indiana

Profile Details

NPI number 1649250523
LBN Legal business name Konicki, Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 18th, 2006
Last updated May 17th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649250523 NPPES
Florida MEDICAID 373993799
Florida Other RAILROAD MEDICARE

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