Provider Demographics
NPI:1437147089
Name:KUPFERER, THOMAS WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:KUPFERER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-1807
Mailing Address - Country:US
Mailing Address - Phone:618-687-2353
Mailing Address - Fax:618-687-9511
Practice Address - Street 1:628 N 14TH ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-1807
Practice Address - Country:US
Practice Address - Phone:618-687-2353
Practice Address - Fax:618-687-9511
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-066913207P00000X
IL036066913261QR1300X, 207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066913-2Medicaid
IL118099OtherHEALTHLINK
IL027368OtherHEALTH ALLIANCE
IL039-00152OtherBCBS
IL039-00152OtherBCBS
IL214881087Medicare PIN
580570Medicare Oscar/Certification
IL580570Medicare PIN
IL027368OtherHEALTH ALLIANCE
IL118099OtherHEALTHLINK