Provider Demographics
NPI:1104862820
Name:HUPFER, THOMAS KENNETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KENNETH
Last Name:HUPFER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15454
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-0454
Mailing Address - Country:US
Mailing Address - Phone:812-475-8900
Mailing Address - Fax:812-475-0024
Practice Address - Street 1:3700 BELLEMEADE AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0106
Practice Address - Country:US
Practice Address - Phone:812-475-8900
Practice Address - Fax:812-475-0024
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000766A213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100121220Medicaid
IN7338450001OtherDME
ININ2066Medicare PIN
U35210Medicare UPIN