Provider Demographics
NPI:1568835445
Name:KOPP MEDICAL LLC
Entity Type:Organization
Organization Name:KOPP MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-633-5155
Mailing Address - Street 1:6720 GRELOT ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-2676
Mailing Address - Country:US
Mailing Address - Phone:251-633-5155
Mailing Address - Fax:251-633-5125
Practice Address - Street 1:6720 GRELOT ROAD SUITE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-2676
Practice Address - Country:US
Practice Address - Phone:251-633-5155
Practice Address - Fax:251-633-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL309662081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty