Healthcare Provider Details

I. General information

NPI: 1346796109
Provider Name (Legal Business Name): DENNIS P KOPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 S 2ND ST
LOUISVILLE KY
40203-2209
US

IV. Provider business mailing address

839 S 2ND ST
LOUISVILLE KY
40203-2209
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-5834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number26612
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: