Healthcare Provider Details

I. General information

NPI: 1992848410
Provider Name (Legal Business Name): VIPUL KAPOOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 W 15TH ST
PLANO TX
75075-7738
US

IV. Provider business mailing address

1820 PRESTON PARK BLVD 1825
PLANO TX
75093-3656
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-6800
  • Fax:
Mailing address:
  • Phone: 972-867-7862
  • Fax: 972-612-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036109811
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: