MEDICARE: DR. JAMES MICHAEL CUPOLI 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	208000000X	Pediatrics Physician	036091251	IL
2	2080P0006X	Developmental - Behavioral Pediatrics Physician	036091251	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1982717351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL CUPOLI M.D.

Provider Business Mailing Address
First Line	:	1101 CARTER STREET
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402
Country	:	US
Telephone Number	:	423-490-7710
Fax Number	:	423-490-7750

Provider Business Practice Location Address
First Line	:	1101 CARTER STREET
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402
Country	:	US
Telephone Number	:	423-490-7710
Fax Number	:	423-490-7750

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	02/22/2013

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