Provider Demographics
NPI:1215382999
Name:KRUPKA, MARIANNE CATHERINE (DO)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:CATHERINE
Last Name:KRUPKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:CATHERINE
Other - Last Name:WITHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:10350 HALIGUS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9526
Mailing Address - Country:US
Mailing Address - Phone:815-356-2323
Mailing Address - Fax:847-802-7201
Practice Address - Street 1:10350 HALIGUS RD STE 120
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9526
Practice Address - Country:US
Practice Address - Phone:815-356-2323
Practice Address - Fax:847-802-7201
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036149752207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics