Healthcare Provider Details

I. General information

NPI: 1174529481
Provider Name (Legal Business Name): INDERJIT K KAPOOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 US HIGHWAY 6
PORTAGE IN
46368-5111
US

IV. Provider business mailing address

6375 US HIGHWAY 6
PORTAGE IN
46368-5111
US

V. Phone/Fax

Practice location:
  • Phone: 219-762-3196
  • Fax: 219-763-6438
Mailing address:
  • Phone: 219-762-3196
  • Fax: 219-763-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01035765A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: