Provider Demographics
NPI:1306835350
Name:CUPINO, ISAIAS R JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ISAIAS
Middle Name:R
Last Name:CUPINO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 S ROSERA ST
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:WI
Mailing Address - Zip Code:54139-9169
Mailing Address - Country:US
Mailing Address - Phone:920-829-6400
Mailing Address - Fax:920-829-6403
Practice Address - Street 1:200 ROSERA ST
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:WI
Practice Address - Zip Code:54139-9169
Practice Address - Country:US
Practice Address - Phone:920-829-6400
Practice Address - Fax:920-829-6403
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI37208020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1851477913OtherCMH NPI
WI1326349135OtherCMH SB NPI
WI1346371358OtherLENA CLINIC NPI
WI1326349135OtherCMH SB NPI
WI011400110Medicare ID - Type Unspecified
WI1851477913OtherCMH NPI
G82863Medicare UPIN