Provider Demographics
NPI:1811973175
Name:RUPAR, KAREN J (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:J
Last Name:RUPAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 W. VAN BUREN STREET
Mailing Address - Street 2:RML SPECIALTY HOSPITAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624
Mailing Address - Country:US
Mailing Address - Phone:773-826-6677
Mailing Address - Fax:
Practice Address - Street 1:3435 W. VAN BUREN STREET
Practice Address - Street 2:RML SPECIALTY HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624
Practice Address - Country:US
Practice Address - Phone:773-826-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004117103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618781OtherBC/BS
ILP00082713OtherMEDICARE RAILROAD
ILP00082713OtherMEDICARE RAILROAD