MEDICARE: MIROSLAW A. KUPTEL M.D. LLC

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
1	261QP2300X	Primary Care Clinic/Center	036.095993	IL

General Provider Information

NPI Number	:	1104143692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIROSLAW A. KUPTEL M.D. LLC

Provider Business Mailing Address
First Line	:	9651 IRVING PARK RD
Second Line	:
City	:	SCHILLER PARK
State	:	IL
Zip	:	60176-1905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9651 IRVING PARK RD
Second Line	:
City	:	SCHILLER PARK
State	:	IL
Zip	:	60176-1905
Country	:	US
Telephone Number	:	847-678-6474
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MIROSLAW A. KUPTEL
Credential	:	M.D.
Telephone Number	:	847-678-6474

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	02/27/2023

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