Provider Demographics
NPI:1508808999
Name:KUPTEL, IRMA (MD)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:KUPTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1115
Mailing Address - Country:US
Mailing Address - Phone:847-653-8413
Mailing Address - Fax:847-292-0850
Practice Address - Street 1:6400 W COLLEGE DR STE 600
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1900
Practice Address - Country:US
Practice Address - Phone:708-425-4662
Practice Address - Fax:708-425-4692
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091117207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10584976OtherCAQH
IL10584976OtherCAQH