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NPI Code Detail

MEDICARE: DR. MARY NELL KIRSCH RUPP MD

MEDICARE: DR. MARY NELL KIRSCH RUPP MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician2007010575MO
2207P00000XEmergency Medicine Physician57547WI
3207P00000XEmergency Medicine Physician200800576MO

General Provider Information

NPI Number : 1407077282
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY NELL KIRSCH RUPP MD
Provider Business Mailing Address
First Line : 1035 KEPLER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8320
Country : US
Telephone Number : 920-490-9046
Fax Number : 920-405-8005
Provider Business Practice Location Address
First Line : 2253 W MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-4706
Country : US
Telephone Number : 920-327-7250
Fax Number : 920-327-7249
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 05/19/2026

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