Basic Information
| Provider Information | |||||||||
| NPI: | 1154501245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAPOOR | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1905 E. HUEBBE PARKWAY | ||||||||
| Address2: | BELOIT HEALTH SYSTEM, INC | ||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535111842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083641219 | ||||||||
| FaxNumber: | 6083641280 | ||||||||
| Practice Location | |||||||||
| Address1: | 5605 E. ROCKTON ROAD | ||||||||
| Address2: | NORTHPOINTE | ||||||||
| City: | ROSCOE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610737601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155254500 | ||||||||
| FaxNumber: | 8155254505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2007 | ||||||||
| LastUpdateDate: | 10/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 036-128053 | IL | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 56029-20 | WI | N | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.