Individual
MACKENZIE ELIZABETH LUPOV
Active
Individual
MACKENZIE ELIZABETH LUPOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11014966A
IN
208M00000X
Hospitalist Physician
11014966A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201074650
—
IN
Enumeration date
08/20/2009
Last updated
11/02/2017
Update your record
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