Healthcare Provider Details

I. General information

NPI: 1720352511
Provider Name (Legal Business Name): EUGENE J KOPROWSKI M.D. (A.M.)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 NORTH DEARBORN ST 3C
CHICAGO IL
60610-1507
US

IV. Provider business mailing address

1415 NORTH DEARBORN ST 3C
CHICAGO IL
60610-1507
US

V. Phone/Fax

Practice location:
  • Phone: 312-221-5954
  • Fax:
Mailing address:
  • Phone: 312-221-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: