Healthcare Provider Details

I. General information

NPI: 1699074237
Provider Name (Legal Business Name): SPENCER GREGORY KUPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 GATEWAY BLVD STE 3100
NEWBURGH IN
47630-7906
US

IV. Provider business mailing address

PO BOX 637273
CINCINNATI OH
45263-7273
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-4550
  • Fax:
Mailing address:
  • Phone: 812-842-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number33952
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number01079619A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: