Provider Demographics
NPI:1063469872
Name:KAPOOR, PRADEEP (MD)
Entity Type:Individual
Prefix:
First Name:PRADEEP
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 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 BELLEVUE AVE STE 305
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1845
Practice Address - Country:US
Practice Address - Phone:314-925-4700
Practice Address - Fax:314-925-4771
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203893813Medicaid
MO000094871Medicare Oscar/Certification
MO135050166Medicare ID - Type UnspecifiedSMHC-MO