Provider Demographics
NPI:1558647354
Name:CUPP, MARIA I (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:CUPP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:I
Other - Last Name:ORLANDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1225 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2368
Mailing Address - Country:US
Mailing Address - Phone:231-935-0788
Mailing Address - Fax:231-935-0787
Practice Address - Street 1:1225 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2368
Practice Address - Country:US
Practice Address - Phone:231-935-0788
Practice Address - Fax:231-935-0787
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006218363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080G310660OtherBLUE CROSS PPO TRUST
MI080G310660OtherBCN COMMERCIAL
MO080G310660OtherBC MEDICARE PLUS BLUE PPO
MI080G310660OtherBLUE CROSS TRADITIONAL
MI080G310660OtherBC BPP
MI080G310660OtherBLUE CROSS PPO TRUST