Provider Demographics
NPI:1295913861
Name:COPP, ELIZABETH S (PAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:COPP
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Gender:F
Credentials:PAC
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Mailing Address - Street 1:10415 GRAND RIVER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6533
Mailing Address - Country:US
Mailing Address - Phone:810-227-1020
Mailing Address - Fax:810-227-4930
Practice Address - Street 1:10415 GRAND RIVER RD
Practice Address - Street 2:STE 100
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6533
Practice Address - Country:US
Practice Address - Phone:810-227-1020
Practice Address - Fax:810-227-4930
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
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Provider Licenses
StateLicense IDTaxonomies
MI5601003217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant