Provider Demographics
NPI:1366440752
Name:KOPESKY, KEVIN ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROY
Last Name:KOPESKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3178
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-3178
Mailing Address - Country:US
Mailing Address - Phone:319-398-1583
Mailing Address - Fax:319-399-2085
Practice Address - Street 1:202 10TH STREET SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2404
Practice Address - Country:US
Practice Address - Phone:319-362-5118
Practice Address - Fax:319-364-0574
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA278542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA56506OtherBLUE CROSS/BLUE SHIELD
IA1067322Medicaid
IA1067322Medicaid
IA56506OtherBLUE CROSS/BLUE SHIELD