Individual
MARCIA KOPACZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN,MSN,CNP
Contact information
Practice address
32270 TELEGRAPH RD, STE 240, BINGHAM FARMS, MI 48025-2456
(248) 593-1717
(248) 593-1711
Mailing address
32270 TELEGRAPH RD, STE 240, BINGHAM FARMS, MI 48025-2456
(248) 593-1717
(248) 593-1711
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
4704088147
MI
363L00000X
Nurse Practitioner
Primary
4704088147
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5008605430
BCBS PROVIDER ID
MI
Enumeration date
11/08/2006
Last updated
02/20/2020
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