Provider Demographics
NPI:1063989580
Name:CUPPY, DANIEL MICHAEL (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:CUPPY
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3580 ARCADE ST
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-7135
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:651-968-5903
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2024-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN12847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant