Provider Demographics
NPI:1699074237
Name:KUPER, SPENCER GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:GREGORY
Last Name:KUPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637273
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7273
Mailing Address - Country:US
Mailing Address - Phone:812-842-4550
Mailing Address - Fax:
Practice Address - Street 1:4199 GATEWAY BLVD STE 3100
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7906
Practice Address - Country:US
Practice Address - Phone:812-842-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33952207VM0101X
IN01079619A207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300010740Medicaid
KY7100523980Medicaid
IN01079619AOtherINDIANA LICENSE