Healthcare Provider Details

I. General information

NPI: 1437184363
Provider Name (Legal Business Name): PREMIER WOMENS HEALTH ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 N RANDALL RD SUITE 360
ELGIN IL
60123-9400
US

IV. Provider business mailing address

1710 N RANDALL RD SUITE 360
ELGIN IL
60123-9400
US

V. Phone/Fax

Practice location:
  • Phone: 847-289-8262
  • Fax: 847-214-5745
Mailing address:
  • Phone: 847-289-8262
  • Fax: 847-214-5745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036084462
License Number StateIL

VIII. Authorized Official

Name: KEVIN A COPLEY
Title or Position: DIRECTOR
Credential: MD
Phone: 847-289-8262