Provider Demographics
NPI:1174532766
Name:KUOPUS, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KUOPUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4133
Mailing Address - Country:US
Mailing Address - Phone:906-225-0923
Mailing Address - Fax:906-225-0306
Practice Address - Street 1:515 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4133
Practice Address - Country:US
Practice Address - Phone:906-225-0923
Practice Address - Fax:906-225-0306
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001551235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI901822472Medicaid