Healthcare Provider Details

I. General information

NPI: 1790390805
Provider Name (Legal Business Name): KIMBERLY HANNAH KUPFERBERG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S FAIRFIELD AVE FL 4
CHICAGO IL
60608-1782
US

IV. Provider business mailing address

1500 SOUTH FAIRFIELD AVENUE NR7-109
CHICAGO IL
60608
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-4325
  • Fax: 773-257-2155
Mailing address:
  • Phone: 773-257-1173
  • Fax: 773-257-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209021982
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: