Provider Demographics
NPI:1497813091
Name:MARCEL KOPPEL, MD, FACP, INC.
Entity type:Organization
Organization Name:MARCEL KOPPEL, MD, FACP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-327-1557
Mailing Address - Street 1:555 E TACHEVAH DR
Mailing Address - Street 2:2W-105
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5750
Mailing Address - Country:US
Mailing Address - Phone:760-327-1557
Mailing Address - Fax:760-327-1317
Practice Address - Street 1:555 E TACHEVAH DR
Practice Address - Street 2:2W 105
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5750
Practice Address - Country:US
Practice Address - Phone:760-327-1557
Practice Address - Fax:760-327-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23686207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A236860Medicaid
CA00A236860Medicaid
CAZZZ03230ZMedicare ID - Type UnspecifiedGROUP NO.
CA00A236861Medicare PIN