Provider Demographics
NPI:1952332918
Name:KOPJAS, TIBOR CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:TIBOR
Middle Name:CHARLES
Last Name:KOPJAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6810 STATE ROUTE 162 BOX 215
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-8501
Mailing Address - Country:US
Mailing Address - Phone:618-391-6405
Mailing Address - Fax:618-288-4088
Practice Address - Street 1:2118 VADALABENE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5632
Practice Address - Country:US
Practice Address - Phone:618-288-7081
Practice Address - Fax:618-288-6857
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036070084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070084Medicaid
IL06000515OtherBLUE CROSS
IL166459OtherGHP
IL100767OtherHEALTHLINK
IL110016002OtherRIALROAD MEDICARE
IL0407247OtherUNITED HEALTH
IL166459OtherGHP
IL0407247OtherUNITED HEALTH