Healthcare Provider Details

I. General information

NPI: 1194836247
Provider Name (Legal Business Name): RUSH COPLEY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2972 INDIAN TRAIL RD SUITE A
AURORA IL
60502-9408
US

IV. Provider business mailing address

1256 WATERFORD DR STE 230
AURORA IL
60504-4511
US

V. Phone/Fax

Practice location:
  • Phone: 630-499-0812
  • Fax: 630-499-0823
Mailing address:
  • Phone: 630-499-2404
  • Fax: 630-692-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCEE A BRUMMEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 630-978-4915