1174517734 NPI number — MRS. KAREN M LUPARELLO D.O.

Table of content: MRS. KAREN M LUPARELLO D.O. (NPI 1174517734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174517734 NPI number — MRS. KAREN M LUPARELLO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUPARELLO
Provider First Name:
KAREN
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174517734
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2295 WOODLAND TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSDALE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49242-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-437-1967
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 W CARLETON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSDALE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49242-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-439-2020
Provider Business Practice Location Address Fax Number:
517-437-5577
Provider Enumeration Date:
09/09/2005

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: 207W00000X , with the licence number:  KL011914 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4495541 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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