Individual
DR. ROBERT G KOPITSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3023 N BALLAS RD STE 200D, SAINT LOUIS, MO 63131-2328
(314) 996-7272
Mailing address
3023 N BALLAS RD STE 200D, SAINT LOUIS, MO 63131-2328
(314) 996-7272
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
R4E32
MO
207RI0011X
Interventional Cardiology Physician
Primary
R4E32
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000047049
MCARE CCL GROUP NUMBER
MO
01
—
002012762
MEDICARE PROVIDER ID
MO
01
—
003013185
MEDICARE PROV ID AREA 99
MO
01
—
060042993
RR MEDICARE NUMBER
MO
01
—
CD6536
RR GROUP 01
MO
01
—
MA1080
CCL MEDICARE GROUP NUMBER
—
01
—
MA1080003
CCL INDIVDUAL PROVIDER NUMBER
MO
01
—
P00275849
CATHLAB RR MCARE
MO
Enumeration date
08/25/2005
Last updated
03/19/2021
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