MEDICARE: DR. SAM P COPELAND DO

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	5151008468	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902878986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAM P COPELAND DO

Provider Business Mailing Address
First Line	:	615 E 8TH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-2630
Country	:	US
Telephone Number	:	231-929-2900
Fax Number	:	231-929-7191

Provider Business Practice Location Address
First Line	:	615 E 8TH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-2630
Country	:	US
Telephone Number	:	231-929-2900
Fax Number	:	231-929-7191

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	02/27/2009

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Directions to “ DR. SAM P COPELAND DO” Practice Location

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