Individual provider · Type 1 NPI

Nicholus Kopacki, PA

Medical Physician Assistant · Grand Rapids, MI

NPI number 1417112004 Active

Practice location

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502

Mailing address

PO Box Q
Grand Rapids, MI 49501-4917

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X5601005277 (MI)

Medical Physician Assistant: Definition to come...

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About NPI 1417112004

Nicholus Kopacki, PA's National Provider Identifier is 1417112004, issued on Jul 23, 2008. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Grand Rapids, MI. The record was last updated on Jul 23, 2008.