Healthcare Provider Details

I. General information

NPI: 1508933573
Provider Name (Legal Business Name): THERESA KUPPY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 PFINGSTEN RD SUITE 330
GLENVIEW IL
60026-1324
US

IV. Provider business mailing address

2650 RIDGE AVE EVANSTON HOSPITAL
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-998-4100
  • Fax: 847-998-5837
Mailing address:
  • Phone: 847-570-1206
  • Fax: 847-570-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-075633
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: