Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2453 | IL |
N | 111NI0900X | Internist | 2453 | IL |
N | 207X00000X | Orthopaedic Surgeon | 1111 | IL |
N | 207XS0117X | Orthopaedic Spine Surgeon | 0000 | NY |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 79992 | GA |
NPI | 1295034551 |
---|---|
Provider Name | Dr. Tomas Kuprys |
First Address | Lagrange, GA 30240-3871 |
Second Address | Lagrange, GA 30240-3871 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2011 |
Last Update Date | 04/06/2019 |