Healthcare Provider Details

I. General information

NPI: 1790068872
Provider Name (Legal Business Name): STUART ROY KUPFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2011
Last Update Date: 09/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAKEDA PKWY
DEERFIELD IL
60015-5713
US

IV. Provider business mailing address

1 TAKEDA PKWY
DEERFIELD IL
60015-5713
US

V. Phone/Fax

Practice location:
  • Phone: 224-554-2207
  • Fax:
Mailing address:
  • Phone: 224-554-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036101821
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: