Individual
DR. ELENA CATHERINE COPPOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
560 W MITCHELL ST, SUITE 185, PETOSKEY, MI 49770-2275
(231) 487-3390
(231) 487-3578
Mailing address
560 W MITCHELL ST, SUITE 185, PETOSKEY, MI 49770-2275
(231) 487-3390
(231) 487-3578
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101017256
MI
207RH0003X
Hematology & Oncology Physician
Primary
5101017256
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760689665
—
MI
01
—
N56640033
MEDICARE PTAN
MI
Enumeration date
07/03/2007
Last updated
09/26/2014
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