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NPI Code Detail

MEDICARE: SEAN W.P. KOPPE M.D.

MEDICARE: SEAN W.P. KOPPE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician36111498IL
2207RI0008XHepatology Physician036111498IL
3207RG0100XGastroenterology Physician036111498IL
4207RT0003XTransplant Hepatology Physician036111498IL

General Provider Information

NPI Number : 1073534681
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEAN W.P. KOPPE M.D.
Provider Business Mailing Address
First Line : 840 S WOOD ST
Second Line : CLINICAL SCIENCES BUILDING (CSB), MC/716
City : CHICAGO
State : IL
Zip : 60612-4325
Country : US
Telephone Number : 312-355-3558
Fax Number : 312-413-2844
Provider Business Practice Location Address
First Line : 840 S WOOD ST
Second Line : CLINICAL SCIENCES BUILDING (CSB), MC/716
City : CHICAGO
State : IL
Zip : 60612-4325
Country : US
Telephone Number : 312-355-3558
Fax Number : 312-413-2844
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 12/29/2014

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