Healthcare Provider Details

I. General information

NPI: 1962494211
Provider Name (Legal Business Name): KAPIL PURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 JUNIPER AVE
NICEVILLE FL
32578-2218
US

IV. Provider business mailing address

PO BOX 524
NICEVILLE FL
32588-0524
US

V. Phone/Fax

Practice location:
  • Phone: 850-279-4600
  • Fax: 850-279-4566
Mailing address:
  • Phone: 850-279-4600
  • Fax: 850-279-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberAPP-000857284
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME91106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: