Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301008227 | MI |
N | 111NI0013X | Independent Medical Examiner | 2301008227 | MI |
N | 111NP0017X | Pediatric Chiropractor | 2301008227 | MI |
N | 111NR0400X | Rehabilitation Chiropractor | 2301008227 | MI |
N | 111NX0100X | Occupational Health | 2301008227 | MI |
N | 225100000X | Physical Therapist | 2301008227 | MI |
NPI | 1851457139 |
---|---|
Provider Name | Dr. Jeffrey Joseph Lupo |
First Address | Roseville, MI 48066-4803 |
Second Address | Roseville, MI 48066-4803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
(NPI #) | COVENTRY / OMNICARE (01) | MI |
139635 | GREAT LAKES NUMBER (01) | MI |
23692 | HEALTH PLAN OF MICHIGAN (01) | MI |
4423140 | (05) | MI |
950G410360 | BLUE CROSS PROVIDER CODE (01) | MI |
JL008227 | LICENSE NUMBER (01) | MI |
P00011506 | RAIL ROAD NUMBER (01) | MI |
U83417 | (02) | MI |