Healthcare Provider Details

I. General information

NPI: 1376537597
Provider Name (Legal Business Name): PRABODH KUMARI KAPILA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NW 82ND AVE SUITE 303
PLANTATION FL
33324-7808
US

IV. Provider business mailing address

201 NW 82ND AVE SUITE 303
PLANTATION FL
33324-7808
US

V. Phone/Fax

Practice location:
  • Phone: 954-370-1153
  • Fax: 954-370-2366
Mailing address:
  • Phone: 954-370-1153
  • Fax: 954-370-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME0046964
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME 46964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: