Basic Information
| Provider Information | |||||||||
| NPI: | 1972594018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOSUPAIT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 HOBSON RD | ||||||||
| Address2: | STE 116 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605408137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304163300 | ||||||||
| FaxNumber: | 6306465648 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 HOBSON RD | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605408137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304163300 | ||||||||
| FaxNumber: | 6306465648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036077089 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 036077089 6 | 05 | IL | MEDICAID |