Healthcare Provider Details

I. General information

NPI: 1306022983
Provider Name (Legal Business Name): OLIVIA MARIE KUPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 UNIVERSITY DR
WEST CHESTER OH
45069-2505
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 513-298-7325
  • Fax: 513-298-7406
Mailing address:
  • Phone: 859-212-4468
  • Fax: 859-212-4357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number41465
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41465
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number41465
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.140256
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: