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General NPI Number Information
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NPI Number | 1639455173
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Entity Type | Organization
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Legal Business Name | RUSH-COPLEY MEDICAL GROUP NFP
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Dates
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Enumeration Date | 10/28/2011
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 2040 OGDEN AVE SUITE 303
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City | AURORA
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State | IL
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Zip | 60504-7206
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Country | US
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Telephone | 630-499-2329
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Fax | 630-898-5837
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Provider Business Mailing Address
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Address Line | 1256 WATERFORD DR STE 230
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City | AURORA
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State | IL
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Zip | 60504-4511
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Country | US
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Telephone | 630-499-2404
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Fax | 630-692-5518
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARCEE A. BRUMMEL
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Credential |
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Telephone | 630-978-4915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | 036-115418
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 036-115418
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-115418
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License Number State | IL
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