Provider Demographics
NPI:1427925171
Name:KUPPE, KONNOR
Entity type:Individual
Prefix:MR
First Name:KONNOR
Middle Name:
Last Name:KUPPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56788 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4942
Mailing Address - Country:US
Mailing Address - Phone:586-345-0037
Mailing Address - Fax:
Practice Address - Street 1:56788 MOUND RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-4942
Practice Address - Country:US
Practice Address - Phone:586-345-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-18
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer