Provider Demographics
NPI:1174517809
Name:KUPPINGER, MITCHELL C (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:C
Last Name:KUPPINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 OMEGA DR STE 208
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2075
Mailing Address - Country:US
Mailing Address - Phone:817-465-5881
Mailing Address - Fax:817-465-6336
Practice Address - Street 1:2941 OAK PARK CIR STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1852
Practice Address - Country:US
Practice Address - Phone:817-332-7433
Practice Address - Fax:817-394-6282
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1100207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119041503Medicaid
TX119041503Medicaid
TX877527Medicare PIN