Basic Information
| Provider Information | |||||||||
| NPI: | 1992722730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOPPIKAR | ||||||||
| FirstName: | VINAYA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1065 NE 125TH ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | NORTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331615833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888526672 | ||||||||
| FaxNumber: | 3058914228 | ||||||||
| Practice Location | |||||||||
| Address1: | 1065 NE 125TH ST | ||||||||
| Address2: | STE 206 | ||||||||
| City: | NORTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331615832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058910050 | ||||||||
| FaxNumber: | 3058910497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME151277 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 260039342 | 01 | MEDICARE RAILROAD | OTHER | 32510700 | 05 | WI | MEDICAID | 390808509 | 01 | CT GENERAL | OTHER | 475887619 | 01 | TRICARE | OTHER | 11766 | 01 | DEAN HEALTH PLAN | OTHER | 390808509 | 01 | CIGNA | OTHER | 90002361 | 01 | WEA INS | OTHER | 390808509 | 01 | WPS | OTHER | 39080850927 | 01 | UNITY | OTHER | 1022445 | 01 | PHYSICIANS PLUS | OTHER | 32510700 | 01 | HIRSP | OTHER | 690004890 | 01 | MEDICARE RAILROAD | OTHER |