Provider Demographics
NPI:1912628512
Name:KOPROLCES, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KOPROLCES
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 1:10591 S AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9407
Mailing Address - Country:US
Mailing Address - Phone:269-352-1986
Mailing Address - Fax:269-204-2530
Practice Address - Street 1:10591 S AVE
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9407
Practice Address - Country:US
Practice Address - Phone:269-352-1986
Practice Address - Fax:269-204-2530
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health