Provider Demographics
NPI:1396738209
Name:KAPOOR, GURBACHAN S (MD)
Entity type:Individual
Prefix:
First Name:GURBACHAN
Middle Name:S
Last Name:KAPOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-6001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4755 AMERITECH DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-9120
Practice Address - Country:US
Practice Address - Phone:574-271-2558
Practice Address - Fax:574-273-1137
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026462A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00051342OtherRAIL ROAD MEDICARE
IN000000251277OtherANTHEM
IN000000251277OtherANTHEM
IN202980BMedicare PIN
INC25106Medicare UPIN