Provider Demographics
NPI:1558990283
Name:COPLIN, BRADLEY (DO)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:COPLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54389 LAWSON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3152
Mailing Address - Country:US
Mailing Address - Phone:817-300-6119
Mailing Address - Fax:
Practice Address - Street 1:251 E PECK RD
Practice Address - Street 2:
Practice Address - City:PECK
Practice Address - State:MI
Practice Address - Zip Code:48466-9589
Practice Address - Country:US
Practice Address - Phone:810-378-4900
Practice Address - Fax:810-378-4905
Is Sole Proprietor?:No
Enumeration Date:2020-04-04
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101028146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program