Provider Demographics
NPI:1154501245
Name:KAPOOR, ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
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 1:1905 E. HUEBBE PARKWAY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM, INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-1219
Mailing Address - Fax:608-364-1280
Practice Address - Street 1:5605 E. ROCKTON ROAD
Practice Address - Street 2:NORTHPOINTE
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-7601
Practice Address - Country:US
Practice Address - Phone:815-525-4500
Practice Address - Fax:815-525-4505
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-128053207N00000X
WI56029-20207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology