Provider Demographics
NPI:1609139583
Name:TUPPER, VINCENT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:MICHAEL
Last Name:TUPPER
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 1:29373 NETWORK PLACE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:3000 N HALSTED ST STE 823
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6185
Practice Address - Country:US
Practice Address - Phone:773-296-7937
Practice Address - Fax:773-296-3995
Is Sole Proprietor?:No
Enumeration Date:2012-06-16
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142276207LP2900X
IL036.142276207L00000X
IN01078148A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine