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General NPI Number Information
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NPI Number | 1184829996
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Entity Type | Organization
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Legal Business Name | THOMAS W. KUPFERER, D.O.
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 407 S CHESTNUT ST
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City | DE SOTO
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State | IL
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Zip | 62924-1400
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Country | US
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Telephone | 618-867-2703
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Fax | 618-867-2353
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Provider Business Mailing Address
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Address Line | 407 S CHESTNUT PO BOX 104
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City | DESOTO
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State | IL
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Zip | 62924-1400
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Country | US
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Telephone | 618-867-2703
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Fax | 618-687-9511
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JANET L AUSTIN
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Credential |
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Telephone | 618-687-2353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 036066913
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036099723
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License Number State | IL
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