Provider Demographics
NPI:1700104619
Name:LUPISAN, KERWIN JOEL ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:KERWIN JOEL
Middle Name:ANTONIO
Last Name:LUPISAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KERWIN
Other - Middle Name:
Other - Last Name:LUPISAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4590 DRESSLER RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2546
Mailing Address - Country:US
Mailing Address - Phone:330-484-1607
Mailing Address - Fax:330-484-2943
Practice Address - Street 1:4590 DRESSLER RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2546
Practice Address - Country:US
Practice Address - Phone:330-484-1607
Practice Address - Fax:330-484-2943
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-121969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine