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NPI Code Detail

MEDICARE: DR. MARK ALAN KOPONEN M.D.

MEDICARE: DR. MARK ALAN KOPONEN M.D.
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
1207ZF0201XForensic Pathology Physician11172ND
2207ZF0201XForensic Pathology Physician52274MN
3207ZF0201XForensic Pathology Physician88-39NM
4207ZF0201XForensic Pathology Physician10086MT
5207ZF0201XForensic Pathology Physician34173GA

General Provider Information

NPI Number : 1336397553
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK ALAN KOPONEN M.D.
Provider Business Mailing Address
First Line : 501 N COLUMBIA RD STOP 9037
Second Line : DEPARTMENT OF PATHOLOGY
City : GRAND FORKS
State : ND
Zip : 58203-2817
Country : US
Telephone Number : 701-777-6172
Fax Number : 701-777-3108
Provider Business Practice Location Address
First Line : 501 N COLUMBIA RD STOP 9037
Second Line : DEPARTMENT OF PATHOLOGY
City : GRAND FORKS
State : ND
Zip : 58203-2817
Country : US
Telephone Number : 701-777-6172
Fax Number : 701-777-3108
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2008
Last Update Date : 11/30/2009

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