Provider Demographics
NPI:1376537597
Name:KAPILA, PRABODH KUMARI (MD)
Entity Type:Individual
Prefix:
First Name:PRABODH
Middle Name:KUMARI
Last Name:KAPILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NW 82ND AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7808
Mailing Address - Country:US
Mailing Address - Phone:954-370-1153
Mailing Address - Fax:954-370-2366
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7808
Practice Address - Country:US
Practice Address - Phone:954-370-1153
Practice Address - Fax:954-370-2366
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046964207RR0500X
FLME 46964207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20965ZOtherMEDICARE INDIVIDUAL PERFORMING PROVIDER ID
FLE31860Medicare UPIN
FL40678Medicare PIN