Individual
MARIA I CUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1225 W FRONT ST, TRAVERSE CITY, MI 49684-2368
(231) 935-0788
(231) 935-0787
Mailing address
1225 W FRONT ST, TRAVERSE CITY, MI 49684-2368
(231) 935-0788
(231) 935-0787
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006218
MI
363AM0700X
Medical Physician Assistant
5601006218
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080G310660
BLUE CROSS PPO TRUST
MI
01
—
080G310660
BC MEDICARE PLUS BLUE PPO
MO
Enumeration date
10/25/2011
Last updated
07/20/2022
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