Provider Demographics
NPI:1477631869
Name:KAPOOR, GOPAL R (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPAL
Middle Name:R
Last Name:KAPOOR
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 1:16111 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5520
Mailing Address - Country:US
Mailing Address - Phone:216-252-8444
Mailing Address - Fax:216-252-2724
Practice Address - Street 1:16111 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111
Practice Address - Country:US
Practice Address - Phone:216-252-8444
Practice Address - Fax:216-252-2724
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043533208000000X, 207R00000X
OH35-043533207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1851587455OtherGROUP NPI
OH9916374OtherMEDICARE GROUP PIN
OH793111449OtherRAILROAD MEDICARE PIN
OHCK3114OtherRAILROAD MEDICARE GROUP PIN
OH0435738Medicaid
OH0484915Medicare PIN
OH1851587455OtherGROUP NPI