=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881791689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW LIFE HEART CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1460 W FAIRBANKS AVE
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-862-4151
-----------------------------------------------------
Fax | 407-862-7495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1460 W FAIRBANKS AVE
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-862-4151
-----------------------------------------------------
Fax | 407-862-7495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | SUNIL KAPOOR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-862-4151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 64999
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------