Provider Demographics
NPI:1114176765
Name:DUA, KAPIL (DPM)
Entity Type:Individual
Prefix:DR
First Name:KAPIL
Middle Name:
Last Name:DUA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E RANDOLPH ST APT 3906
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5052
Mailing Address - Country:US
Mailing Address - Phone:734-904-1027
Mailing Address - Fax:
Practice Address - Street 1:8919 PARALLEL PKWY STE 550
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1545
Practice Address - Country:US
Practice Address - Phone:913-321-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00442213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001621735OtherBCBS NUMBER
IL203263002OtherMEDICARE PTAN