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General NPI Number Information
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NPI Number | 1811956980
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Entity Type | Individual
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Provider Name | MICAL J KUPKE M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/18/2006
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 77 NEALY BLVD
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City | LANGLEY AFB
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State | VA
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Zip | 23665-2023
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Country | US
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Telephone | 757-764-3260
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Fax |
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Provider Business Mailing Address
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Address Line | 114 PELICAN PL
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City | YORKTOWN
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State | VA
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Zip | 23692-2983
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Country | US
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Telephone | 757-225-8001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 010106772
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101056772
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 0101056772
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License Number State | VA
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