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General NPI Number Information
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NPI Number | 1336388586
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Entity Type | Individual
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Provider Name | FABIOLLA SIQUEIRA KOPP MD
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Gender | Female
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 506
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City | CHICAGO
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State | IL
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Zip | 60602-3837
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Country | US
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Telephone | 773-312-4423
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Fax | 773-312-4522
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Provider Business Mailing Address
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Address Line | 30 N MICHIGAN AVE STE 506
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City | CHICAGO
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State | IL
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Zip | 60602-3837
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Country | US
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Telephone | 773-312-4423
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Fax | 773-312-4522
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036147419
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | Q5683
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License Number State | TX
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