Healthcare Provider Details

I. General information

NPI: 1215678727
Provider Name (Legal Business Name): RICHARD CAPONE II DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 STULTS RD
HUNTINGTON IN
46750-1291
US

IV. Provider business mailing address

608 UNION CHAPEL RD
FORT WAYNE IN
46845-9357
US

V. Phone/Fax

Practice location:
  • Phone: 260-482-5091
  • Fax:
Mailing address:
  • Phone: 260-482-5091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02009093A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: