Healthcare Provider Details

I. General information

NPI: 1861429755
Provider Name (Legal Business Name): MATTHIAS H KAPTURCZAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 MEDICAL DR STE 105
SAN ANTONIO TX
78229-3342
US

IV. Provider business mailing address

7142 SAN PEDRO AVE SUITE 120
SAN ANTONIO TX
78216-6254
US

V. Phone/Fax

Practice location:
  • Phone: 210-692-7228
  • Fax: 210-692-9671
Mailing address:
  • Phone: 210-661-5622
  • Fax: 210-798-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25618
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM7318
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: