Healthcare Provider Details

I. General information

NPI: 1427636547
Provider Name (Legal Business Name): MICHAEL WILLIAM KOULOPOULOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HARRISON ST
SYRACUSE NY
13202-3188
US

IV. Provider business mailing address

110 TRENT LN
CAMILLUS NY
13031-1616
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4472
  • Fax:
Mailing address:
  • Phone: 339-933-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA206587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: