Healthcare Provider Details

I. General information

NPI: 1265425995
Provider Name (Legal Business Name): GEORGE KUPER C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13207 RAVENNA RD GEAUGA HOSPITAL
CHARDON OH
44024-7032
US

IV. Provider business mailing address

PO BOX 567
CHAGRIN FALLS OH
44022-0567
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-6000
  • Fax:
Mailing address:
  • Phone: 216-464-5160
  • Fax: 216-464-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number118108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: