Individual
CHARLES F KOOPMANN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 EAST MEDICAL CENTER DRIVE, 2ND FLOOR TAUBMAN CTR RECP G, ANN ARBOR, MI 48109-5312
(734) 936-5730
Mailing address
3621 S STATE ST, 700 KMS PLACE ATTN: ELLEN KAYFES, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
4301050068
MI
207YP0228X
Pediatric Otolaryngology Physician
4301050068
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0811423
BCBSM
MI
05
—
1741795
—
MI
Enumeration date
04/19/2006
Last updated
03/29/2012
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