Provider Demographics
NPI:1316140262
Name:KONOPKA, JORGE (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:KONOPKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORGE
Other - Middle Name:
Other - Last Name:CURBELO KONOPKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1951 SW 172ND AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5593
Mailing Address - Country:US
Mailing Address - Phone:954-320-7999
Mailing Address - Fax:954-320-7601
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029
Practice Address - Country:US
Practice Address - Phone:954-320-7999
Practice Address - Fax:954-320-7601
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103846207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 103846OtherFL LICENSE
FLCJ127XMedicare UPIN
FL001237900Medicaid