Provider Demographics
NPI:1235398462
Name:KOPPY-AUSTIN, MICHAELINE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAELINE
Middle Name:
Last Name:KOPPY-AUSTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 POWDERHORN DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-9567
Mailing Address - Country:US
Mailing Address - Phone:989-366-8948
Mailing Address - Fax:
Practice Address - Street 1:319 POWDERHORN DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-9567
Practice Address - Country:US
Practice Address - Phone:989-366-8948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine