Provider Demographics
NPI:1467430090
Name:KAPPOS, GEORGE T (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:T
Last Name:KAPPOS
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 1:1010 S THIRD ST
Mailing Address - Street 2:1A
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-1165
Mailing Address - Country:US
Mailing Address - Phone:515-984-6426
Mailing Address - Fax:515-984-6428
Practice Address - Street 1:1010 S 3RD ST
Practice Address - Street 2:1A
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-1130
Practice Address - Country:US
Practice Address - Phone:515-984-6426
Practice Address - Fax:515-984-6428
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080108761OtherRR MEDICARE
IA3161380Medicaid
IA4161380Medicaid
IA6161380Medicaid
IA2161380Medicaid
IA080108761OtherRR MEDICARE
IA6161380Medicaid