MEDICARE: DR. CHRISTOPHER C 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
1	208600000X	Surgery Physician	2007014918	MO
2	208600000X	Surgery Physician	57691-020	WI

General Provider Information

NPI Number	:	1568681831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER C RUPP MD

Provider Business Mailing Address
First Line	:	PO BOX 22487
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54305-2487
Country	:	US
Telephone Number	:	920-445-7226
Fax Number	:	920-445-7229

Provider Business Practice Location Address
First Line	:	720 S VANBUREN ST
Second Line	:	SUITE 201
City	:	GREEN BAY
State	:	WI
Zip	:	54301-3534
Country	:	US
Telephone Number	:	920-433-7488
Fax Number	:	920-433-7439

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	01/03/2020

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