Individual
MS. CAROLYN S KOPPENOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
15774 STATE STREET, HILLMAN, MI 49746-0427
(989) 742-4583
(989) 742-2183
Mailing address
PO BOX 427, HILLMAN, MI 49746-0427
(989) 354-2197
(989) 356-6524
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301046030
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5104939
—
MI
01
—
CK046030
STATE LICENSE NUMBER
MI
Enumeration date
01/06/2007
Last updated
10/09/2012
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