Provider Demographics
NPI:1528496122
Name:KOPLEJEWSKI, KATARZYNA
Entity type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:
Last Name:KOPLEJEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44200 WOODWARD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5046
Mailing Address - Country:US
Mailing Address - Phone:248-253-9600
Mailing Address - Fax:269-253-0980
Practice Address - Street 1:44200 WOODWARD AVE STE 103
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-253-9600
Practice Address - Fax:248-253-0980
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006828363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical