| Organization Name: | MIROSLAW A. KUPTEL M.D. LLC |
| NPI Number: | 1104143692 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MIROSLAW A. KUPTEL (PRESIDENT) |
| Mailing Address: | 9651 Irving Park Rd Schiller Park |
| State: | IL US |
| Postal Code: | 601761905 |
| Phone Number: | 8476786474 |
| Fax Number: | |
| NPI Enumeration Date: | 04/23/2010 |
| NPI Last Update Date: | 04/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 036.095993 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |