Healthcare Provider Details

I. General information

NPI: 1063400802
Provider Name (Legal Business Name): KATHERINE A SCHUPPERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N ROSEMONT BLVD
TUCSON AZ
85712-2139
US

IV. Provider business mailing address

4881 E GRANT RD
TUCSON AZ
85712-2704
US

V. Phone/Fax

Practice location:
  • Phone: 520-881-1977
  • Fax: 520-881-1979
Mailing address:
  • Phone: 520-795-0549
  • Fax: 520-795-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number16718
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: