Provider Demographics
NPI:1548374119
Name:CAPPIELLO MEDICAL CLINIC PA
Entity type:Organization
Organization Name:CAPPIELLO MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPPIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-938-8443
Mailing Address - Street 1:4915 MILE STRETCH DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-4334
Mailing Address - Country:US
Mailing Address - Phone:727-938-8443
Mailing Address - Fax:
Practice Address - Street 1:4915 MILE STRETCH DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-4334
Practice Address - Country:US
Practice Address - Phone:727-938-8443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NO
FLQ0556Medicare PIN