Provider Demographics
NPI:1962494211
Name:PURI, KAPIL (MD)
Entity type:Individual
Prefix:
First Name:KAPIL
Middle Name:
Last Name:PURI
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:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32588-0524
Mailing Address - Country:US
Mailing Address - Phone:850-279-4600
Mailing Address - Fax:850-279-4566
Practice Address - Street 1:1110 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2218
Practice Address - Country:US
Practice Address - Phone:850-279-4600
Practice Address - Fax:850-279-4566
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000857284208800000X
FLME91106208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50070YOtherMEDICARE ID TYPE UNSPECIFIED
FL270922800Medicaid
I19133Medicare UPIN