Lupov, Mackenzie Elizabeth
Lupov, Mackenzie Elizabeth is an individual health care provider with primary practice located at 601 W 2Nd St , Bloomington IN 47403-2317. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Lupov, Mackenzie Elizabeth can be contacted via phone (812) 676-4542.Contact Information
Primary practice address
601 W 2Nd St
Bloomington IN 47403-2317
Phone: (812) 676-4542
Fax: (812) 676-4106
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 11014966A | Indiana |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 11014966A | Indiana |
Profile Details
| NPI number | 1336371509 |
|---|---|
| LBN Legal business name | Lupov, Mackenzie Elizabeth |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 20th, 2009 |
| Last updated | Nov 2nd, 2017 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336371509 | NPPES |
| Indiana | MEDICAID | 201074650 |
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