1154501245 NPI number — DR. ROGER KAPOOR MD

Table of content: DR. ROGER KAPOOR MD (NPI 1154501245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154501245 NPI number — DR. ROGER KAPOOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAPOOR
Provider First Name:
ROGER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154501245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1905 E. HUEBBE PARKWAY
Provider Second Line Business Mailing Address:
BELOIT HEALTH SYSTEM, INC
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53511-1842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-364-1219
Provider Business Mailing Address Fax Number:
608-364-1280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5605 E. ROCKTON ROAD
Provider Second Line Business Practice Location Address:
NORTHPOINTE
Provider Business Practice Location Address City Name:
ROSCOE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61073-7601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-525-4500
Provider Business Practice Location Address Fax Number:
815-525-4505
Provider Enumeration Date:
11/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  036-128053 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207N00000X , with the licence number: 56029-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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