Provider Demographics
NPI:1093735979
Name:KUPER, KRIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:A
Last Name:KUPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1921
Mailing Address - Country:US
Mailing Address - Phone:406-268-1600
Mailing Address - Fax:460-771-3549
Practice Address - Street 1:1600 DIVISION RD
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1921
Practice Address - Country:US
Practice Address - Phone:406-268-1600
Practice Address - Fax:460-771-3549
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38714208000000X
MT21374208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG40047Medicare UPIN
MTM011003206Medicare PIN