Provider Demographics
NPI:1518983964
Name:KOPITZKI, HAROLD P (DO)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:P
Last Name:KOPITZKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24423 KENSINGTON
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2188
Mailing Address - Country:US
Mailing Address - Phone:810-442-0386
Mailing Address - Fax:
Practice Address - Street 1:30901 PALMER RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-9529
Practice Address - Country:US
Practice Address - Phone:734-367-8403
Practice Address - Fax:734-722-9524
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010Q26258OtherBCBSM GR#
MIHK007269OtherLICENSE
MI1508883299OtherWRPH
MI4867164Medicaid
MI234035Medicare Oscar/Certification
MIHK007269OtherLICENSE