Healthcare Provider Details

I. General information

NPI: 1982717351
Provider Name (Legal Business Name): JAMES MICHAEL CUPOLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CARTER STREET
CHATTANOOGA TN
37402
US

IV. Provider business mailing address

1101 CARTER STREET
CHATTANOOGA TN
37402
US

V. Phone/Fax

Practice location:
  • Phone: 423-490-7710
  • Fax: 423-490-7750
Mailing address:
  • Phone: 423-490-7710
  • Fax: 423-490-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036091251
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number036091251
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: