Provider Information for 1922471523
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REEGAN KOPPELMAN
Sex: Female
NPI: 1922471523
Last Updated: 2017-04-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1922471523 | ||||||||
| Enumeration Date | 2015-11-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4670 LIPSCOMB ST NE STE 11 PALM BAY, FL 32905-2927 United States Phone: 407-875-3700 | Fax:407-659-0411 | ||||||||
| Primary Practice Address | 4670 LIPSCOMB ST NE PALM BAY, FL 32905-2927 United States Phone: 321-726-2889 | Fax:321-726-2889 | ||||||||
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