Healthcare Provider Details

I. General information

NPI: 1801363353
Provider Name (Legal Business Name): DAVID ALAN KUPSKI APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 W TALCOTT AVE
CHICAGO IL
60631-3707
US

IV. Provider business mailing address

6814 N KNOX AVE
LINCOLNWOOD IL
60712-2416
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-8000
  • Fax:
Mailing address:
  • Phone: 847-331-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209017187
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: