Provider Demographics
NPI:1831182807
Name:KOPITSKY, ROBERT G (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:KOPITSKY
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 1:3023 N BALLAS RD STE 200D
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2328
Mailing Address - Country:US
Mailing Address - Phone:314-996-7272
Mailing Address - Fax:
Practice Address - Street 1:3023 N BALLAS RD STE 200D
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2328
Practice Address - Country:US
Practice Address - Phone:314-996-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4E32207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1080003OtherCCL INDIVDUAL PROVIDER NUMBER
MOP00275849OtherCATHLAB RR MCARE
MA1080OtherCCL MEDICARE GROUP NUMBER
MO002012762OtherMEDICARE PROVIDER ID
MO060042993OtherRR MEDICARE NUMBER
MO000047049OtherMCARE CCL GROUP NUMBER
MO003013185OtherMEDICARE PROV ID AREA 99
MOCD6536OtherRR GROUP 01
MO060042993OtherRR MEDICARE NUMBER