MEDICARE: DR. SHAILENDRA KAPOOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101245670	VA
2	207Q00000X	Family Medicine Physician	036.119478	IL
3	207Q00000X	Family Medicine Physician	076590	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C09633	OTHER	VA	GROUP PTAN
2	C05698	OTHER	VA	GROUP PTAN
3	C06778	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1184894859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAILENDRA KAPOOR MD

Provider Business Mailing Address
First Line	:	3495 PIEDMONT RD NE
Second Line	:	NINE PIEDMONT CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30305-1717
Country	:	US
Telephone Number	:	404-504-5678
Fax Number	:	804-741-6213

Provider Business Practice Location Address
First Line	:	1100 LAKE HEARN DR STE 250&500
Second Line	:	KAISER PERMANENTE SANDY SPRINGS MEDICAL CENTER
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-1523
Country	:	US
Telephone Number	:	404-845-4500
Fax Number	:	804-741-6213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2008
Last Update Date	:	01/10/2022

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