Provider Demographics
NPI:1437264645
Name:KOPEL, MARK J (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:KOPEL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:11150 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2702
Mailing Address - Country:US
Mailing Address - Phone:810-632-6380
Mailing Address - Fax:810-632-6601
Practice Address - Street 1:11150 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2702
Practice Address - Country:US
Practice Address - Phone:810-632-6380
Practice Address - Fax:810-632-6601
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2012-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIMK008618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF05092Medicare UPIN
MIM79070001Medicare PIN