Healthcare Provider Details

I. General information

NPI: 1477631869
Provider Name (Legal Business Name): GOPAL R KAPOOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 LORAIN AVE
CLEVELAND OH
44111
US

IV. Provider business mailing address

16111 LORAIN AVE
CLEVELAND OH
44111-5520
US

V. Phone/Fax

Practice location:
  • Phone: 216-252-8444
  • Fax: 216-252-2724
Mailing address:
  • Phone: 216-252-8444
  • Fax: 216-252-2724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35043533
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number35-043533
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35043533
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: