Provider Demographics
NPI:1285836171
Name:KAPOOR, SHRUTI G (MD)
Entity Type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:G
Last Name:KAPOOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHRUTI
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3663 RIDGE MILL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7799
Practice Address - Country:US
Practice Address - Phone:614-788-4440
Practice Address - Fax:614-788-4459
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.126813208VP0000X, 207LP2900X, 208VP0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0152959Medicaid