Provider Demographics
NPI:1407828791
Name:KAPUCHINSKI, STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:KAPUCHINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STANLEY
Other - Middle Name:
Other - Last Name:KAPUCHINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:25166 MARION AVENUE, SUITE 111
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950
Mailing Address - Country:US
Mailing Address - Phone:941-205-3333
Mailing Address - Fax:941-205-3334
Practice Address - Street 1:25166 MARION AVE STE 111
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4052
Practice Address - Country:US
Practice Address - Phone:941-205-3333
Practice Address - Fax:941-205-3334
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME865712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2666910 01Medicaid
FL2666910 01Medicaid
FL57795AMedicare ID - Type Unspecified