Provider Demographics
NPI:1356757934
Name:STANCUKAS, MARY CAROLINE (DPM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CAROLINE
Last Name:STANCUKAS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:215 OLD HIGHWAY 1187
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-0281
Mailing Address - Country:US
Mailing Address - Phone:817-926-2663
Mailing Address - Fax:817-293-8860
Practice Address - Street 1:215 OLD HIGHWAY 1187
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-0281
Practice Address - Country:US
Practice Address - Phone:817-926-2663
Practice Address - Fax:817-293-8860
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135000840213ES0103X
TX2287213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery