Healthcare Provider Details

I. General information

NPI: 1952509457
Provider Name (Legal Business Name): ELISABETH MARTA KUPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 TANGLEWOOD LN, E1
SILVERTHORNE CO
80498
US

IV. Provider business mailing address

PO BOX 1292
FRISCO CO
80443-1292
US

V. Phone/Fax

Practice location:
  • Phone: 970-468-1003
  • Fax: 970-262-2196
Mailing address:
  • Phone: 970-668-1791
  • Fax: 970-262-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMR-0938
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-10576
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: