Provider Demographics
NPI:1255350112
Name:CAPILI, CARLEO A (MD)
Entity type:Individual
Prefix:
First Name:CARLEO
Middle Name:A
Last Name:CAPILI
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 1:1501 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3143
Mailing Address - Country:US
Mailing Address - Phone:817-481-5365
Mailing Address - Fax:827-424-3264
Practice Address - Street 1:1501 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3143
Practice Address - Country:US
Practice Address - Phone:817-481-5365
Practice Address - Fax:827-424-3264
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1348207Q00000X, 208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098208403Medicaid
TX098208403Medicaid
TX8F23498Medicare PIN