Provider Demographics
NPI:1124214093
Name:KAPERONIS, VASILIOS W (MD)
Entity Type:Individual
Prefix:DR
First Name:VASILIOS
Middle Name:W
Last Name:KAPERONIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:30 ACOMA BLVD S
Mailing Address - Street 2:#101-103
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5957
Mailing Address - Country:US
Mailing Address - Phone:928-680-0604
Mailing Address - Fax:928-680-0605
Practice Address - Street 1:30 ACOMA BLVD S
Practice Address - Street 2:#101-103
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5957
Practice Address - Country:US
Practice Address - Phone:928-680-0604
Practice Address - Fax:928-680-0605
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ207322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ61723Medicare PIN