Provider Demographics
NPI:1235297920
Name:KOPRIVICA, PRESTON BRENT (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:BRENT
Last Name:KOPRIVICA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10127 LEAVENWORTH RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-3050
Mailing Address - Country:US
Mailing Address - Phone:913-894-1143
Mailing Address - Fax:913-894-4055
Practice Address - Street 1:10127 LEAVENWORTH RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-3050
Practice Address - Country:US
Practice Address - Phone:913-894-1143
Practice Address - Fax:913-894-4055
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5B85207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine