Healthcare Provider Details

I. General information

NPI: 1871836536
Provider Name (Legal Business Name): MARIJAN KOPRIVANAC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # J4-1
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # J4-1
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-444-2035
  • Fax:
Mailing address:
  • Phone: 215-444-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35141683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: