Provider Demographics
NPI:1285604371
Name:KOPP, WILLIAM JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:KOPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2101 JACKSON ST
Mailing Address - Street 2:SUITE #208
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4388
Mailing Address - Country:US
Mailing Address - Phone:765-646-8448
Mailing Address - Fax:765-683-3130
Practice Address - Street 1:2101 JACKSON ST
Practice Address - Street 2:SUITE #208
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4388
Practice Address - Country:US
Practice Address - Phone:765-646-8448
Practice Address - Fax:765-683-3130
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01028142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5986267OtherAETNA
IN000000084851OtherBLUE CROSS-BLUE SHIELD
IN021761912OtherMEDICARE RAILROAD
IN7885580002OtherCIGNA
IN1001711230AMedicaid
IND69733Medicare UPIN
IN1001711230AMedicaid