MEDICARE: DR. KAREN J. RUPAR PSY.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	103T00000X	Psychologist	071004117	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00082713	OTHER	IL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01618781	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1811973175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN J. RUPAR PSY.D.

Provider Business Mailing Address
First Line	:	3435 W. VAN BUREN STREET
Second Line	:	RML SPECIALTY HOSPITAL
City	:	CHICAGO
State	:	IL
Zip	:	60624
Country	:	US
Telephone Number	:	773-826-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 W. VAN BUREN STREET
Second Line	:	RML SPECIALTY HOSPITAL
City	:	CHICAGO
State	:	IL
Zip	:	60624
Country	:	US
Telephone Number	:	773-826-6677
Fax Number	:

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	05/25/2011

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