Provider Demographics
NPI:1720215569
Name:KOPEC, MICHAEL ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:KOPEC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2219 MENARD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-4142
Mailing Address - Country:US
Mailing Address - Phone:217-553-4171
Mailing Address - Fax:
Practice Address - Street 1:222 S WOODS MILL RD STE 550N
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3641
Practice Address - Country:US
Practice Address - Phone:314-542-4798
Practice Address - Fax:314-205-6916
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2009015797207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology