Provider Demographics
NPI:1295488641
Name:IRMA KUPTEL MD SC
Entity type:Organization
Organization Name:IRMA KUPTEL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-425-4662
Mailing Address - Street 1:221 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1115
Mailing Address - Country:US
Mailing Address - Phone:847-334-3710
Mailing Address - Fax:
Practice Address - Street 1:6400 W COLLEGE DR
Practice Address - Street 2:STE 600
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1900
Practice Address - Country:US
Practice Address - Phone:708-425-4662
Practice Address - Fax:708-425-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty