Provider Demographics
NPI:1699706465
Name:KAPUSTA, RONALD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:KAPUSTA
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 1:3012 E HEBRON PARKWAY
Mailing Address - Street 2:STE 104
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4428
Mailing Address - Country:US
Mailing Address - Phone:972-394-0200
Mailing Address - Fax:972-492-3390
Practice Address - Street 1:3012 E HEBRON PARKWAY
Practice Address - Street 2:STE 104
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4428
Practice Address - Country:US
Practice Address - Phone:972-394-0200
Practice Address - Fax:972-492-3390
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8015207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
88C067Medicare ID - Type Unspecified
B23839Medicare UPIN