Healthcare Provider Details

I. General information

NPI: 1508055351
Provider Name (Legal Business Name): RUSH-COPLEY MEDICAL GROUP, NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4789 ROUTE 71
OSWEGO IL
60543-7415
US

IV. Provider business mailing address

1256 WATERFORD DR STE 230
AURORA IL
60504-4511
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-6204
  • Fax:
Mailing address:
  • Phone: 630-499-2404
  • Fax: 630-692-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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