Provider Demographics
NPI:1780093765
Name:KAPSALIS, ANDREW (DPM)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KAPSALIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8607 E US HIGHWAY 36 STE 100
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7960
Mailing Address - Country:US
Mailing Address - Phone:317-745-5403
Mailing Address - Fax:
Practice Address - Street 1:8607 E US HIGHWAY 36 STE 100
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7960
Practice Address - Country:US
Practice Address - Phone:317-745-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135000862213E00000X
IN07001248A213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty