Individual
THOMAS R COPPOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3999 DUTCHMANS LN STE 7B, LOUISVILLE, KY 40207-4742
(502) 896-4711
(502) 896-4791
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
04045
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001101368
ANTHEM
KY
01
—
230950
SIHO
KY
05
—
300007832
—
IN
05
—
7100487210
—
KY
01
—
K250100
MEDICARE
KY
Enumeration date
05/22/2012
Last updated
04/11/2024
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