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General NPI Number Information
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NPI Number | 1225119928
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Entity Type | Organization
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Legal Business Name | NORTHERN ILLINOIS PLASTIC SURGERY CONSULTANTS LTD
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2127 MIDLANDS CT 102
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City | SYCAMORE
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State | IL
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Zip | 60178-3173
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Country | US
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Telephone | 815-758-3057
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Fax | 630-323-2391
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Provider Business Mailing Address
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Address Line | 950 N YORK RD SUITE 201
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City | HINSDALE
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State | IL
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Zip | 60521
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Country | US
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Telephone | 630-323-2369
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Fax | 630-323-2391
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Authorized Official
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Title or Position | MD
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Name | DR. RICHARD KOPOLOVIC
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Credential | MD
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Telephone | 630-323-2369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State | IL
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