Provider Demographics
NPI:1295399251
Name:KOPEL, ROBERTA LYNN (DVM)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LYNN
Last Name:KOPEL
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-1260
Mailing Address - Country:US
Mailing Address - Phone:320-523-5550
Mailing Address - Fax:320-523-5551
Practice Address - Street 1:1605 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1260
Practice Address - Country:US
Practice Address - Phone:320-523-5550
Practice Address - Fax:320-523-5551
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FK2459813OtherDEA