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General NPI Number Information
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NPI Number | 1780801456
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Entity Type | Organization
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Legal Business Name | FAMILY UROLOGY ASSOCIATES, PLC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 1000 E PARIS AVE SE SUITE 205
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3680
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Country | US
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Telephone | 616-942-8868
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Fax | 616-942-8363
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Provider Business Mailing Address
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Address Line | 1000 E PARIS AVE SE SUITE 205
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3680
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Country | US
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Telephone | 616-942-8868
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Fax | 616-942-8363
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Authorized Official
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Title or Position | PRINCIPLE
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Name | DR. JOHN H. KOPCHICK
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Credential | M.D.
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Telephone | 616-942-8868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4301043886
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License Number State | MI
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