Provider Demographics
NPI:1912943499
Name:RICHARD A KOEPKE,DO,PLC
Entity Type:Organization
Organization Name:RICHARD A KOEPKE,DO,PLC
Other - Org Name:BEDFORD FAMILY PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOEPKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-854-5441
Mailing Address - Street 1:3309 QUAIL HOLLOW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-8688
Mailing Address - Country:US
Mailing Address - Phone:734-854-5441
Mailing Address - Fax:734-854-7441
Practice Address - Street 1:3309 QUAIL HOLLOW DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-8688
Practice Address - Country:US
Practice Address - Phone:734-854-5441
Practice Address - Fax:734-854-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION8890Medicare ID - Type UnspecifiedFAMILY PRACTICE