Provider Demographics
NPI:1194833269
Name:DUA, KAPIL (PT)
Entity Type:Individual
Prefix:
First Name:KAPIL
Middle Name:
Last Name:DUA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30445 NORTHWESTERN HWY
Mailing Address - Street 2:STE. 280
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3158
Mailing Address - Country:US
Mailing Address - Phone:248-865-7380
Mailing Address - Fax:248-865-7480
Practice Address - Street 1:30445 NORTHWESTERN HWY
Practice Address - Street 2:STE. 280
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3158
Practice Address - Country:US
Practice Address - Phone:248-865-7380
Practice Address - Fax:248-865-7480
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E05734OtherBCBS NUMBER
MIP00036123OtherMEDICARE RAILROAD