Basic Information
| Provider Information | |||||||||
| NPI: | 1437196425 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KUPSKY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 E MAPLE RD | ||||||||
| Address2: | SUITE 400-CREDENTIALING | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480831138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137458555 | ||||||||
| FaxNumber: | 3139668989 | ||||||||
| Practice Location | |||||||||
| Address1: | 3990 JOHN R ST | ||||||||
| Address2: | HARPER HOSPITAL PATHOLOGY | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137458555 | ||||||||
| FaxNumber: | 3137459299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZN0500X | 4301058791 | MI | N | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | 207ZP0101X | 4301058791 | MI | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.