Healthcare Provider Details

I. General information

NPI: 1124609094
Provider Name (Legal Business Name): SABRINA HOPE COPPEDGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SABRINA HC KROGER

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W LAKE ST STE 41983
CHICAGO IL
60606-0239
US

IV. Provider business mailing address

201 W LAKE ST STE 41983
CHICAGO IL
60606-1803
US

V. Phone/Fax

Practice location:
  • Phone: 312-248-9988
  • Fax: 864-448-1459
Mailing address:
  • Phone: 312-248-9988
  • Fax: 864-448-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.172821
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: