Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0430814 | KS |
N | 207QS0010X | Family Doctor - Sports Medicine | 0430814 | KS |
Y | 207QS0010X | Family Doctor - Sports Medicine | 35.124490 | OH |
NPI | 1114985173 |
---|---|
Provider Name | Dr. Sean A. Cupp |
First Address | Cleveland, OH 44106-1716 |
Second Address | Euclid, OH 44117-1714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 02/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0109771 | (05) | OH |
200307140A | (05) | KS |
I16525 | (02) |