Provider Demographics
NPI:1902878986
Name:COPELAND, SAM P (DO)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:P
Last Name:COPELAND
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 1:615 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2630
Mailing Address - Country:US
Mailing Address - Phone:231-929-2900
Mailing Address - Fax:231-929-7191
Practice Address - Street 1:615 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2630
Practice Address - Country:US
Practice Address - Phone:231-929-2900
Practice Address - Fax:231-929-7191
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151008468204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI113507254Medicaid
MIE26723Medicare UPIN
MI5283081Medicare ID - Type Unspecified