Provider Demographics
NPI:1164402160
Name:KOPYRINA, MARIYA (MD)
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:KOPYRINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 KERCHEVAL AVE
Mailing Address - Street 2:PIERSON CLINIC
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3629
Mailing Address - Country:US
Mailing Address - Phone:313-343-5919
Mailing Address - Fax:313-343-6131
Practice Address - Street 1:131 KERCHEVAL AVE
Practice Address - Street 2:PIERSON CLINIC
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3629
Practice Address - Country:US
Practice Address - Phone:313-343-5919
Practice Address - Fax:313-343-6131
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I30768Medicare UPIN