Individual
DR. STACEY KACIUBAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1600 S ANDREWS AVE, EMERGENCY DEPARTMENT, FORT LAUDERDALE, FL 33316-2510
(954) 355-4400
(954) 468-8035
Mailing address
110 N FEDERAL HWY, UNIT 914, FORT LAUDERDALE, FL 33301-1180
(954) 591-2224
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME102063
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000235600
—
FL
01
—
91683
BCBS
FL
Enumeration date
04/23/2008
Last updated
11/18/2009
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