Healthcare Provider Details

I. General information

NPI: 1487692489
Provider Name (Legal Business Name): JOHN F CAPACCHIONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/27/2023
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 33100
APO AE
09180-3100
US

IV. Provider business mailing address

UNIT 33100
APO AE
09180-3100
US

V. Phone/Fax

Practice location:
  • Phone: 612-503-7504
  • Fax:
Mailing address:
  • Phone: 612-503-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number60408
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: