1154404671 NPI number — CAROLE SUZANNE J KUPISZEWSKI P.T., I.M.T., C.

Table of content: CAROLE SUZANNE J KUPISZEWSKI P.T., I.M.T., C. (NPI 1154404671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154404671 NPI number — CAROLE SUZANNE J KUPISZEWSKI P.T., I.M.T., C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUPISZEWSKI
Provider First Name:
CAROLE SUZANNE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., I.M.T., C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KUPISZEWSKI
Provider Other First Name:
C. SUZANNE
Provider Other Middle Name:
JOSEPH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, IMTC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154404671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 E 5TH AVE
Provider Second Line Business Mailing Address:
STE. 235
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-3177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-219-0091
Provider Business Mailing Address Fax Number:
630-219-0029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 E 5TH AVE
Provider Second Line Business Practice Location Address:
STE. 235
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-3177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-219-0091
Provider Business Practice Location Address Fax Number:
630-219-0029
Provider Enumeration Date:
10/21/2006

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: 225100000X , with the licence number:  070001948 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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