Basic Information
| Provider Information | |||||||||
| NPI: | 1275969750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOPKA | ||||||||
| FirstName: | STEFAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 TOWNER ST | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481985752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345443000 | ||||||||
| FaxNumber: | 7345446732 | ||||||||
| Practice Location | |||||||||
| Address1: | 2140 E ELLSWORTH RD | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481082552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342223400 | ||||||||
| FaxNumber: | 7349712487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2013 | ||||||||
| LastUpdateDate: | 08/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801058474 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.