Healthcare Provider Details

I. General information

NPI: 1932248077
Provider Name (Legal Business Name): CHRISTINE HELEN KOPEL PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 HIGHLAND RD
HARTLAND MI
48353
US

IV. Provider business mailing address

11150 HIGHLAND RD
HARTLAND MI
48353
US

V. Phone/Fax

Practice location:
  • Phone: 810-632-6380
  • Fax: 810-632-6601
Mailing address:
  • Phone: 810-632-6380
  • Fax: 810-632-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002895
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: