Provider Demographics
NPI:1043264641
Name:KAPOOR, SANDEEP (MD)
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:KAPOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43896
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-0896
Mailing Address - Country:US
Mailing Address - Phone:502-523-0719
Mailing Address - Fax:
Practice Address - Street 1:2109 CLUB VISTA PL
Practice Address - Street 2:BUSINESS OFFICE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5224
Practice Address - Country:US
Practice Address - Phone:502-530-0916
Practice Address - Fax:502-719-1124
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64018518Medicaid
KY64018518Medicaid
KYH08582Medicare UPIN