MEDICARE: DR. VINCENT MICHAEL TUPPER 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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	036142276	IL
2	207L00000X	Anesthesiology Physician	036.142276	IL
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	01078148A	IN

General Provider Information

NPI Number	:	1609139583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT MICHAEL TUPPER M.D.

Provider Business Mailing Address
First Line	:	29373 NETWORK PLACE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:	847-390-4757

Provider Business Practice Location Address
First Line	:	3000 N HALSTED ST STE 823
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6185
Country	:	US
Telephone Number	:	773-296-7937
Fax Number	:	773-296-3995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2012
Last Update Date	:	04/05/2024

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Directions to “ DR. VINCENT MICHAEL TUPPER M.D.” Practice Location

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