Provider Demographics
NPI:1679595086
Name:RUPP, ALICE M (DO)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:M
Last Name:RUPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4050 HEALTHWAY DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8183
Mailing Address - Country:US
Mailing Address - Phone:630-318-3355
Mailing Address - Fax:630-701-9277
Practice Address - Street 1:4050 HEALTHWAY DR
Practice Address - Street 2:SUITE 140
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8183
Practice Address - Country:US
Practice Address - Phone:630-318-3355
Practice Address - Fax:630-701-9277
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036083796207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL271168698OtherTAX ID#
IL110240875OtherMEDICARE RAILROAD
IL0222075OtherBLUE CROSS GROUP NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID
IL036083796Medicaid
IL271168698OtherTAX ID#
IL036083796Medicaid
ILL94056Medicare PIN