Individual
JENNIFER R. MICKE-KOPETSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6425 W MEQUON RD, MEQUON, WI 53092-1855
(262) 242-0051
(262) 242-8927
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28560
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31488700
—
WI
01
—
P00854893
RR MEDICARE
WI
Enumeration date
07/10/2006
Last updated
11/23/2021
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