Provider Demographics
NPI:1013184233
Name:CAPPS, ANTHONY DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DAVID
Last Name:CAPPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:47 W POLK ST
Mailing Address - Street 2:STE 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2171
Mailing Address - Country:US
Mailing Address - Phone:312-427-0774
Mailing Address - Fax:312-427-0775
Practice Address - Street 1:47 W POLK ST
Practice Address - Street 2:STE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2171
Practice Address - Country:US
Practice Address - Phone:312-427-0774
Practice Address - Fax:312-427-0775
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-115000207Q00000X, 207Q00000X
LADO019717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1392596Medicaid
LA1392596Medicaid
LA55770Medicare PIN