Provider Demographics
NPI:1144378084
Name:SCHUPP, CHRISTIAN MARK (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MARK
Last Name:SCHUPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13802 CENTERFIELD DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-6043
Mailing Address - Country:US
Mailing Address - Phone:281-737-0902
Mailing Address - Fax:
Practice Address - Street 1:13802 CENTERFIELD DR STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6043
Practice Address - Country:US
Practice Address - Phone:281-737-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J21AOtherGROUP MEDICARE NUMBER
TX219170206Medicaid
TX094010801OtherGROUP MEDICAID NUMBER