Healthcare Provider Details

I. General information

NPI: 1720495369
Provider Name (Legal Business Name): DANIEL KUPERSMIT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

IV. Provider business mailing address

7031 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

V. Phone/Fax

Practice location:
  • Phone: 305-740-3353
  • Fax:
Mailing address:
  • Phone: 305-740-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberUO4300
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0060984
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: