Provider Demographics
NPI:1245321215
Name:KUPPERMAN, GERARD L (PHD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:L
Last Name:KUPPERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 TIMBERLINE CT E
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4007
Mailing Address - Country:US
Mailing Address - Phone:262-567-1727
Mailing Address - Fax:
Practice Address - Street 1:888 THACKERAY TRL
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4342
Practice Address - Country:US
Practice Address - Phone:262-567-7639
Practice Address - Fax:262-567-7476
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41102700Medicaid
WIS10209Medicare UPIN