Healthcare Provider Details

I. General information

NPI: 1841503158
Provider Name (Legal Business Name): ATUL KAPOOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 02/16/2023
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

BOX 103204
GAINESVILLE FL
32610-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0655
  • Fax: 989-466-3633
Mailing address:
  • Phone: 352-265-0651
  • Fax: 352-265-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME154009
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301103770
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME154009
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: