Provider Demographics
NPI:1447782487
Name:KUPER, SARAH CORDOVA (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:CORDOVA
Last Name:KUPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:RENEE
Other - Last Name:CORDOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 30388
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85275-0388
Mailing Address - Country:US
Mailing Address - Phone:480-830-3900
Mailing Address - Fax:480-830-3901
Practice Address - Street 1:4555 E INVERNESS AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4630
Practice Address - Country:US
Practice Address - Phone:480-830-3900
Practice Address - Fax:480-830-3901
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NML20367164W00000X
CODR.0069466207RS0012X
NM390200000X
AZ75883207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program