Provider Demographics
NPI:1043532799
Name:STUART L WANUCK M D P A
Entity Type:Organization
Organization Name:STUART L WANUCK M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:L
Authorized Official - Last Name:WANUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-686-1707
Mailing Address - Street 1:1920 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3512
Mailing Address - Country:US
Mailing Address - Phone:561-686-1707
Mailing Address - Fax:561-686-1709
Practice Address - Street 1:1920 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3512
Practice Address - Country:US
Practice Address - Phone:561-686-1707
Practice Address - Fax:561-686-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty