Healthcare Provider Details

I. General information

NPI: 1568414985
Provider Name (Legal Business Name): MICHAEL RICHARD RUPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 E LOHMAN AVE STE A
LAS CRUCES NM
88011-8287
US

IV. Provider business mailing address

3800 E LOHMAN AVE STE A
LAS CRUCES NM
88011-8287
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-6500
  • Fax: 575-522-0591
Mailing address:
  • Phone: 575-522-6500
  • Fax: 575-522-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD2006-0458
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD2006-0458
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: