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General NPI Number Information
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NPI Number | 1982043097
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Entity Type | Individual
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Provider Name | RYAN KOOPERMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 767 PARK AVE W STE 2800
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2400
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Country | US
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Telephone | 847-926-6506
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Fax |
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Provider Business Mailing Address
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Address Line | 767 PARK AVE WEST HIGHLAND PARK HOSPITAL
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3707
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Country | US
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Telephone | 847-432-1558
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036.140707
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 125062720
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License Number State | IL
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