Healthcare Provider Details

I. General information

NPI: 1073206389
Provider Name (Legal Business Name): JESSICA LEE KOPCHIA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-6489
  • Fax: 248-471-8837
Mailing address:
  • Phone: 248-551-6489
  • Fax: 248-471-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number5151016410
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: