Provider Demographics
NPI:1699771766
Name:KUPPER, THOMAS E (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:KUPPER
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 1:3006 N COUNTY ROAD 25A
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1373
Mailing Address - Country:US
Mailing Address - Phone:937-335-3518
Mailing Address - Fax:937-332-6857
Practice Address - Street 1:3006 N COUNTY ROAD 25A
Practice Address - Street 2:SUITE 104
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1373
Practice Address - Country:US
Practice Address - Phone:937-335-3518
Practice Address - Fax:937-332-6857
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052300K207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0600102Medicaid
OHD97896Medicare UPIN
OH0600102Medicaid
OHH079351Medicare PIN
OHKU0627201Medicare ID - Type Unspecified