Basic Information
| Provider Information | |||||||||
| NPI: | 1982632055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUPKA | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1741 E MORTEN AVE | ||||||||
| Address2: | SUITE C-1 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850204645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028700194 | ||||||||
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| Practice Location | |||||||||
| Address1: | BANNER BAYWOOD MEDICAL CENTER | ||||||||
| Address2: | 6644 E. BAYWOOD AVE | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803212000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/30/2007 | ||||||||
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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 | 207P00000X | 18704 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.