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NPI Code Detail

MEDICARE: TERRY W KOPP MD

MEDICARE: TERRY W KOPP MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician31109MN

General Provider Information

NPI Number : 1184675431
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY W KOPP MD
Provider Business Mailing Address
First Line : 5200 FAIRVIEW BLVD
Second Line :
City : WYOMING
State : MN
Zip : 55092-8013
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11725 STINSON AVE
Second Line :
City : CHISAGO CITY
State : MN
Zip : 55013-9542
Country : US
Telephone Number : 651-257-8499
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 06/16/2008

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