Healthcare Provider Details

I. General information

NPI: 1699410258
Provider Name (Legal Business Name): EMMA CHRISTINE FLYNN-KOPKO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29751 LITTLE MACK AVE STE B
ROSEVILLE MI
48066-6504
US

IV. Provider business mailing address

29751 LITTLE MACK AVE STE B
ROSEVILLE MI
48066-6504
US

V. Phone/Fax

Practice location:
  • Phone: 586-415-6200
  • Fax:
Mailing address:
  • Phone: 586-415-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101029247
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: