Provider Demographics
NPI:1104305911
Name:KOPKAU, HALEY (MD)
Entity type:Individual
Prefix:DR
First Name:HALEY
Middle Name:
Last Name:KOPKAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MEDICAL CAMPUS DR # MI49684
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7823
Mailing Address - Country:US
Mailing Address - Phone:231-935-8000
Mailing Address - Fax:231-935-8099
Practice Address - Street 1:1400 MEDICAL CAMPUS DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7823
Practice Address - Country:US
Practice Address - Phone:231-935-8000
Practice Address - Fax:231-935-8099
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4351050785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program