Healthcare Provider Details

I. General information

NPI: 1144516352
Provider Name (Legal Business Name): THOMAS KOPP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 CHERRY ST
TOLEDO OH
43608-2673
US

IV. Provider business mailing address

3036 HOPEWELL PL
TOLEDO OH
43606-3104
US

V. Phone/Fax

Practice location:
  • Phone: 419-322-3232
  • Fax:
Mailing address:
  • Phone: 248-246-8055
  • Fax: 949-266-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0000000000
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301098885
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: