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NPI Code Detail

MEDICARE: DR. KENNETH G. KUPKE M.D.

MEDICARE: DR. KENNETH G. KUPKE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080N0001XNeonatal-Perinatal Medicine Physician034637GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053319228
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH G. KUPKE M.D.
Provider Business Mailing Address
First Line : 5901 PEACHTREE DUNWOODY RD NE
Second Line : SUITE B 420
City : ATLANTA
State : GA
Zip : 30328-5382
Country : US
Telephone Number : 404-252-9751
Fax Number : 678-990-5763
Provider Business Practice Location Address
First Line : 5901 PEACHTREE DUNWOODY RD NE
Second Line : SUITE B 420
City : ATLANTA
State : GA
Zip : 30328-5382
Country : US
Telephone Number : 404-252-9751
Fax Number : 678-990-5763
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 04/13/2011

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