Individual
DR. TIMOTHY M CUPERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENBUSH STREET, LAFAYETTE, IN 47904-2479
(765) 448-8000
(765) 448-7625
Mailing address
1200 W WHITE RIVER BLVD, RCS PROVIDER ENROLLMENT, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01063056A
IN
207Y00000X
Otolaryngology Physician
35608
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000526754
ANTHEM PROVIDER NUMBER
IN
05
—
200866630
—
IN
Enumeration date
08/30/2006
Last updated
03/04/2021
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