Provider Demographics
NPI:1700848884
Name:WANUCK, STUART L (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:L
Last Name:WANUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:WANUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE
Mailing Address - Street 1:1920 PALM BEACH LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3505
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:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55777Medicare UPIN
FL50663Medicare ID - Type Unspecified