Provider Demographics
NPI:1164752184
Name:SANGEETA KAPOOR, PLLC
Entity Type:Organization
Organization Name:SANGEETA KAPOOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANGEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-543-9124
Mailing Address - Street 1:2109 CLUB VISTA PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5224
Mailing Address - Country:US
Mailing Address - Phone:502-523-0719
Mailing Address - Fax:812-610-8181
Practice Address - Street 1:2109 CLUB VISTA PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5224
Practice Address - Country:US
Practice Address - Phone:502-523-0719
Practice Address - Fax:812-610-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38469207R00000X
KY3009429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01418Medicare PIN