Provider Demographics
NPI:1982785309
Name:KAPOOR, SHIV SUMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIV
Middle Name:SUMAN
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 1:4652 PARTNERS PLACE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011
Mailing Address - Country:US
Mailing Address - Phone:513-603-8720
Mailing Address - Fax:513-603-8739
Practice Address - Street 1:4652 PARTNERS PLACE
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011
Practice Address - Country:US
Practice Address - Phone:513-603-8720
Practice Address - Fax:513-603-8739
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042317207R00000X
OH35.132511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100388470BMedicaid
OH0363454Medicaid
INF85367Medicare UPIN