Individual
MS. KATHARYN DESA LUPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
636 RAYMOND DR, NAPERVILLE, IL 60563-9789
(630) 922-2350
(630) 922-2070
Mailing address
636 RAYMOND DR, NAPERVILLE, IL 60563-9789
(630) 922-2350
(630) 922-2070
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036138404
IL
208000000X
Pediatrics Physician
036138404
IL
208000000X
Pediatrics Physician
MD448210
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036138404
—
IL
01
—
920540
MEDICARE PTAN GROUP
IL
01
—
F400228991
MEDICARE PTAN INDIVIDUAL
IL
Enumeration date
04/21/2009
Last updated
02/08/2018
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