Basic Information
| Provider Information | |||||||||
| NPI: | 1184894859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAPOOR | ||||||||
| FirstName: | SHAILENDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3495 PIEDMONT RD NE | ||||||||
| Address2: | NINE PIEDMONT CENTER | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303051717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045045678 | ||||||||
| FaxNumber: | 8047416213 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 LAKE HEARN DR STE 250&500 | ||||||||
| Address2: | KAISER PERMANENTE SANDY SPRINGS MEDICAL CENTER | ||||||||
| City: | SANDY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048454500 | ||||||||
| FaxNumber: | 8047416213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2008 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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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 | 207Q00000X | 0101245670 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036.119478 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 076590 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | C09633 | 01 | VA | GROUP PTAN | OTHER | C05698 | 01 | VA | GROUP PTAN | OTHER | C06778 | 01 | VA | GROUP PTAN | OTHER |