Provider Demographics
NPI:1780801456
Name:FAMILY UROLOGY ASSOCIATES, PLC
Entity type:Organization
Organization Name:FAMILY UROLOGY ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOPCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-942-8868
Mailing Address - Street 1:1000 E PARIS AVE SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3680
Mailing Address - Country:US
Mailing Address - Phone:616-942-8868
Mailing Address - Fax:616-942-8363
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:SUITE 205
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3680
Practice Address - Country:US
Practice Address - Phone:616-942-8868
Practice Address - Fax:616-942-8363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043886208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1005357OtherMCLAREN HEALTH PLAN
MI104135289Medicaid
MI900002217OtherPRIORITY HEALTH
MI3404100631OtherCOMMUNITY CHOICE
MID72836Medicare UPIN
MI0M87300Medicare PIN