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Individual

LUKE KOPULOS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
804 SERVICE ROAD, ROOM D100, EAST LALNSING, MI 48824-7062
(517) 355-5053
(517) 432-4394
Mailing address
804 SERVICE ROAD, ROOM D100, EAST LALNSING, MI 48824-7062
(517) 355-5053
(517) 432-4394

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036-136931
IL
2085R0202X
Diagnostic Radiology Physician
4301102549
MI
390200000X
Student in an Organized Health Care Education/Training Program
125052708
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1245436013
MI
Enumeration date
06/26/2007
Last updated
04/26/2021
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