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Individual

DR. CARL D COPPOLA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3950 KRESGE WAY STE 402, LOUISVILLE, KY 40207-5914
(502) 893-3683
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0325

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
28995
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000045699
ANTHEM
KY
01
040011473
RAILROAD MEDICARE
KY
01
1052620
PASSPORT
KY
01
2862
BCBS
KY
05
64289952
KY
Enumeration date
10/07/2005
Last updated
04/14/2023
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