Provider Demographics
NPI:1437162278
Name:JUPA, JAMES EDWARD (MD,)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:JUPA
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:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-0431
Mailing Address - Country:US
Mailing Address - Phone:847-775-7686
Mailing Address - Fax:847-735-9301
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-615-5419
Practice Address - Fax:847-615-5423
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL036041939207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036041939Medicaid
IL04927816OtherBC/BS ILLINOIS
IL998460Medicare ID - Type Unspecified
IL04927816OtherBC/BS ILLINOIS