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General NPI Number Information
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NPI Number | 1467863365
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Entity Type | Individual
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Provider Name | MARIA OPOLKA DO
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Gender | Female
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 810 HOGSBACK RD STE A
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City | MASON
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State | MI
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Zip | 48854-9396
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Country | US
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Telephone | 517-205-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 810 HOGSBACK RD
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City | MASON
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State | MI
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Zip | 48854-9394
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Country | US
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Telephone | 517-244-0434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101021077
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License Number State | MI
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