=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720293046
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL C STUPICH M.S. CCC-A, FAAA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 12/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 E MAIN ST
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53094-3874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-206-8433
-----------------------------------------------------
Fax | 920-262-0883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 615 E MAIN ST
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53094-3874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-206-8433
-----------------------------------------------------
Fax | 920-262-0883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 52156
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------