Provider Demographics
NPI:1891093019
Name:JAMES E JUPA MD SC
Entity Type:Organization
Organization Name:JAMES E JUPA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:JUPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-615-5419
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-0431
Mailing Address - Country:US
Mailing Address - Phone:847-775-7686
Mailing Address - Fax:847-735-9301
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-615-5419
Practice Address - Fax:847-615-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036041939207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty