Healthcare Provider Details

I. General information

NPI: 1841579893
Provider Name (Legal Business Name): RUSH-COPLEY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W VETERANS PKWY SUITE 200
YORKVILLE IL
60560-4728
US

IV. Provider business mailing address

1256 WATERFORD DR STE 230
AURORA IL
60504-4511
US

V. Phone/Fax

Practice location:
  • Phone: 630-820-4040
  • Fax: 630-978-1240
Mailing address:
  • Phone: 630-499-2404
  • Fax: 630-692-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036073955
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036073955
License Number StateIL

VIII. Authorized Official

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