Healthcare Provider Details

I. General information

NPI: 1336231539
Provider Name (Legal Business Name): SAMUEL M DICAPUA MS, DO, CHIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 8TH ST
BONITA SPRINGS FL
34134-7452
US

IV. Provider business mailing address

92 8TH ST
BONITA SPRINGS FL
34134-7452
US

V. Phone/Fax

Practice location:
  • Phone: 207-281-2720
  • Fax:
Mailing address:
  • Phone: 207-281-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19852
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1303
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: