Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicholus Kopacki, PA

Individual provider Medical Physician Assistant · NPI 1417112004

Nicholus Kopacki, PA is a Medical Physician Assistant in Grand Rapids, Michigan. Licensed in Michigan. Registered with an NPI since 2008.

Licensed in
MI
In the registry since
2008
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone: (800) 968-6866
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 5601005277 (MI)

Record details

NPI number1417112004
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJuly 23, 2008
Last updated in NPPESJuly 23, 2008

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