Healthcare Provider Details

I. General information

NPI: 1174532766
Provider Name (Legal Business Name): PETER KUOPUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W WASHINGTON ST
MARQUETTE MI
49855-4133
US

IV. Provider business mailing address

515 W WASHINGTON ST
MARQUETTE MI
49855-4133
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-0923
  • Fax: 906-225-0306
Mailing address:
  • Phone: 906-225-0923
  • Fax: 906-225-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number001551
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: