MEDICARE: CHRISTINA MARIE KOPKA

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
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1598287534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE KOPKA

Provider Business Mailing Address
First Line	:	311 N HOLBROOK ST
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-1487
Country	:	US
Telephone Number	:	734-536-9174
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 N HOLBROOK ST
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-1487
Country	:	US
Telephone Number	:	734-536-9174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	07/21/2022

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Directions to “ CHRISTINA MARIE KOPKA ” Practice Location

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