Healthcare Provider Details

I. General information

NPI: 1518974633
Provider Name (Legal Business Name): EDWIN EDWARD KOPYTKO MS, RN, CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIFTH AVENUE AND ROOSEVELT ROAD
HINES IL
60141
US

IV. Provider business mailing address

8918 OXFORD ST
WOODRIDGE IL
60517-4967
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-4572
Mailing address:
  • Phone: 708-202-8387
  • Fax: 708-202-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: