Provider Demographics
NPI:1891733952
Name:KAPOOR, OM P (MD)
Entity Type:Individual
Prefix:DR
First Name:OM
Middle Name:P
Last Name:KAPOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10981 HICKORY TRACE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2319
Mailing Address - Country:US
Mailing Address - Phone:904-312-9201
Mailing Address - Fax:904-312-9202
Practice Address - Street 1:4131 UNIVERSITY BLVD S STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4346
Practice Address - Country:US
Practice Address - Phone:904-312-9201
Practice Address - Fax:904-312-9202
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101418207QS0010X, 207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00641042OtherRAILROAD MEDICARE
FL281253300Medicaid
FLI20258Medicare UPIN
FLAK074ZMedicare PIN