Individual
CHARLES L LUPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
27650 FERRY RD, SUITE 100, WARRENVILLE, IL 60555-3845
(630) 225-2663
Mailing address
27650 FERRY RD, SUITE 100, WARRENVILLE, IL 60555-3845
(630) 225-2663
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036137806
IL
207X00000X
Orthopaedic Surgery Physician
MT195527
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN GROUP
IL
01
—
F400226647
MEDICARE PTAN INDIVIDUAL
IL
Enumeration date
08/13/2009
Last updated
07/23/2015
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