Provider Demographics
NPI:1760410559
Name:CUPP, CHRISTIAN E (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:E
Last Name:CUPP
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 1:201 ALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871
Mailing Address - Country:US
Mailing Address - Phone:620-872-2187
Mailing Address - Fax:620-872-7193
Practice Address - Street 1:201 ALBERT AVE
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871
Practice Address - Country:US
Practice Address - Phone:620-872-2187
Practice Address - Fax:620-872-7193
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429370207Q00000X
KS04-29370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100642430BMedicaid
KS522210OtherFIRST GUARD
KS103714OtherBCBS
P00131462OtherTRAVELERS UNITED HLTHCARE
H55122Medicare UPIN
KS100642430BMedicaid