Healthcare Provider Details

I. General information

NPI: 1235469255
Provider Name (Legal Business Name): SANDEEP KAPOOR, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 CLUB VISTA PL
LOUISVILLE KY
40245-5224
US

IV. Provider business mailing address

PO BOX 43896
LOUISVILLE KY
40253-0896
US

V. Phone/Fax

Practice location:
  • Phone: 502-931-8331
  • Fax: 502-348-3275
Mailing address:
  • Phone: 502-931-8331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35485
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SANDEEP KAPOOR
Title or Position: OWNER
Credential: MD
Phone: 502-931-8331