Provider Demographics
NPI:1922276682
Name:HOPKINS, MILAN LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MILAN
Middle Name:LEWIS
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:UPPER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95485-0638
Mailing Address - Country:US
Mailing Address - Phone:707-275-2366
Mailing Address - Fax:707-275-9043
Practice Address - Street 1:9425 MAIN ST
Practice Address - Street 2:
Practice Address - City:UPPER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95485-9602
Practice Address - Country:US
Practice Address - Phone:707-275-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34406208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C344060Medicare UPIN