Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 110621 | MO |
NPI | 1003820150 |
---|---|
Provider Name | Michael Cupp |
First Address | Columbia, MO 65201-8131 |
Second Address | Columbia, MO 65201-8131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 09/12/2021 |