Provider Demographics
NPI:1255324679
Name:KUPISZEWSKI, STANLEY J (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:J
Last Name:KUPISZEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1215
Mailing Address - Country:US
Mailing Address - Phone:407-649-6878
Mailing Address - Fax:407-843-7381
Practice Address - Street 1:1222 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1215
Practice Address - Country:US
Practice Address - Phone:407-649-6878
Practice Address - Fax:407-843-7381
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30473207X00000X
GA045273207X00000X
FLME0066643207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00800764BMedicaid
FL275656100Medicaid
GA00800764BMedicaid
G64822Medicare UPIN
FLAA172YMedicare PIN
FL275656100Medicaid
FLAA172ZMedicare PIN