Provider Demographics
NPI:1467600213
Name:SHIV SUMAN KAPOOR PC
Entity Type:Organization
Organization Name:SHIV SUMAN KAPOOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:U
Authorized Official - Last Name:KAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-234-0665
Mailing Address - Street 1:1728 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2830
Mailing Address - Country:US
Mailing Address - Phone:765-825-4044
Mailing Address - Fax:765-825-4110
Practice Address - Street 1:1728 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2830
Practice Address - Country:US
Practice Address - Phone:765-825-4044
Practice Address - Fax:765-825-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF85367Medicare UPIN