Provider Demographics
NPI:1518138544
Name:STEVE KOLPACOFF MD
Entity Type:Organization
Organization Name:STEVE KOLPACOFF MD
Other - Org Name:STEPHEN KOLPACOFF MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLPACOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-842-4445
Mailing Address - Street 1:105 E OBERLIN RD
Mailing Address - Street 2:P O BOX 1146
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-9645
Mailing Address - Country:US
Mailing Address - Phone:530-842-4445
Mailing Address - Fax:530-842-9054
Practice Address - Street 1:101 E OBERLIN ROAD
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-1146
Practice Address - Country:US
Practice Address - Phone:530-842-4445
Practice Address - Fax:530-842-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G611320OtherBLUE SHIELD
CAE24838Medicare PIN
CA00G611320OtherBLUE SHIELD