Stacey Kaciuban, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

ME102063 Issued in FL

Practice address

1600 S Andrews Ave
Emergency Department
Fort Lauderdale, FL 33316-2510

Phone

(954) 355-4400

Fax

(954) 468-8035

NPI assigned

Apr 23, 2008

Last updated

Nov 18, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258502400000",
    "number": "1548435365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N FEDERAL HWY",
            "address_2": "UNIT 914",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333011180",
            "telephone_number": "954-591-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-355-4400",
            "fax_number": "954-468-8035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACIUBAN",
        "first_name": "STACEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-23",
        "last_updated": "2009-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME102063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "91683",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000235600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lorena Kaelber, CNM
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• Danielle Marie Kahn, APRN

• Emergency Medicine Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.