Provider Demographics
NPI:1932190857
Name:KAPPELER, KEITH BRIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:BRIAN
Last Name:KAPPELER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3750
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-3750
Mailing Address - Country:US
Mailing Address - Phone:727-595-5600
Mailing Address - Fax:727-595-8844
Practice Address - Street 1:13201 WALSINGHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3518
Practice Address - Country:US
Practice Address - Phone:727-595-5600
Practice Address - Fax:727-595-8844
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E2281Medicare ID - Type Unspecified
G89441Medicare UPIN