Provider Demographics
NPI:1407856420
Name:SCHUPP, DANIEL G (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:SCHUPP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 7366
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-7366
Mailing Address - Country:US
Mailing Address - Phone:320-257-5595
Mailing Address - Fax:320-257-5596
Practice Address - Street 1:1990 CONNECTICUT AVE S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2554
Practice Address - Country:US
Practice Address - Phone:320-257-5595
Practice Address - Fax:320-257-5596
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2011-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN367032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP48858OtherHEALTH PARTNERS
MN411772562OtherTRICARE
MN411772562OtherGREATWEST HEALTHCARE
MN978725900Medicaid
MN108628C561OtherUCARE OF MINNESOTA
MN16-03044OtherMEDICA
MN2274043OtherARAZ/ AMERICA'S PPO
MN965251042462OtherPREFERRED ONE
MN973N1SCOtherBLUE CROSS BLUE SHIELD
MN411772562OtherGREATWEST HEALTHCARE
MN108628C561OtherUCARE OF MINNESOTA