Provider Demographics
NPI:1245203553
Name:KOPIN, MYRON (MD)
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:KOPIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 415
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1871
Mailing Address - Country:US
Mailing Address - Phone:248-656-1222
Mailing Address - Fax:248-650-4575
Practice Address - Street 1:1135 W UNIVERSITY DR
Practice Address - Street 2:SUITE 415
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-656-1222
Practice Address - Fax:248-650-4575
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMK036050207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0706300142OtherBCBSM
MI382288652OtherCOMM
MI06300149071Medicare ID - Type Unspecified
MI0706300142OtherBCBSM