Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A100158 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 036128033 | IL |
NPI | 1174726509 |
---|---|
Provider Name | Dr. Joanna Rose Kuppy |
First Address | Chicago, IL 60612-3833 |
Second Address | Chicago, IL 60612-3833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 17/08/2011 |