Healthcare Provider Details

I. General information

NPI: 1881041085
Provider Name (Legal Business Name): LUCAS ADRIAAN ANTON COPPES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1693 QUENTIN ST
AURORA CO
80045-2518
US

IV. Provider business mailing address

1693 QUENTIN ST
AURORA CO
80045-2518
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-3000
  • Fax: 720-848-3015
Mailing address:
  • Phone: 720-848-3000
  • Fax: 720-848-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125068422
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0063950
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: