MEDICARE: CHRISTI M TUPA M.D.

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
1	208000000X	Pediatrics Physician	L4769	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0029JV	OTHER	TX	BLUE CROSS PROVIDER NUMER
2	00100267	OTHER	TX	CHIPS PROVIDER ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558366914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTI M TUPA M.D.

Provider Business Mailing Address
First Line	:	6000 S STAPLES ST
Second Line	:	SUITE 406
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-2952
Country	:	US
Telephone Number	:	361-993-4835
Fax Number	:	361-993-7043

Provider Business Practice Location Address
First Line	:	6000 S STAPLES ST
Second Line	:	SUITE 406
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-2952
Country	:	US
Telephone Number	:	361-993-4835
Fax Number	:	361-993-7043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	06/17/2014

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Directions to “ CHRISTI M TUPA M.D.” Practice Location

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