Healthcare Provider Details

I. General information

NPI: 1528496122
Provider Name (Legal Business Name): KATARZYNA KOPLEJEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48980 WOODWARD AVE
PONTIAC MI
48342-5034
US

IV. Provider business mailing address

PO BOX 430150
PONTIAC MI
48343-0150
US

V. Phone/Fax

Practice location:
  • Phone: 248-253-9600
  • Fax: 248-724-7500
Mailing address:
  • Phone: 248-253-9600
  • Fax: 269-253-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601006828
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: