Provider Demographics
NPI:1588649875
Name:KOPEC, KEITH J (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:KOPEC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:202 10TH ST SE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2404
Mailing Address - Country:US
Mailing Address - Phone:319-364-7101
Mailing Address - Fax:319-363-1993
Practice Address - Street 1:202 10TH ST SE
Practice Address - Street 2:SUITE 225
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2404
Practice Address - Country:US
Practice Address - Phone:319-364-7101
Practice Address - Fax:319-363-1993
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2013-05-24
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Provider Licenses
StateLicense IDTaxonomies
IA31274207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1588649875Medicaid
IAP00833585OtherRR MEDICARE
IA1588649875Medicaid
IAIB1600005Medicare PIN
IAIB1598005Medicare PIN