Healthcare Provider Details

I. General information

NPI: 1235236241
Provider Name (Legal Business Name): PAUL COPPS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 N. RTE. 47
SUGAR GROVE IL
60554
US

IV. Provider business mailing address

2040 OGDEN AVE. SUITE 313
AURORA IL
60504-7222
US

V. Phone/Fax

Practice location:
  • Phone: 630-466-6000
  • Fax: 630-466-6001
Mailing address:
  • Phone: 630-499-2404
  • Fax: 630-499-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036109034
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3922
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ5734
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: